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					          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired



               Army Suicide Prevention Program


  “Shoulder-To-Shoulder: No Soldier
           Stands Alone”

                                                                   Intervention
                                                                     Training
                                                                    Scenarios




G-1, Human Resources Policy Directorate                                             3 September 2008   1
                                 Scenario #1 – Pre-deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired


  The Soldier is an eighteen year old, active duty PVT (E2) whose unit will deploy
  to Iraq by the end of next month. This is his/her first deployment. He/she has
  heard many horrifying war stories from veterans who have deployed to Iraq.
  He/she suddenly feels quite uncomfortable with thought of deploying to Iraq.
  Every day he/she is becoming more and more anxious about this deployment.
  He/she is feeling quite powerless and overwhelmed. He/she has heard about
  several ways to avoid deployment. Frequently, he/she has been told that, to
  avoid being deployed, make a suicide gesture. As everyday passes, he/she
  finds him-herself thinking more and more about this COA.

  The Soldier is talking to the First Sergeant about these thoughts.

  What the First Sergeant does not know:
         1. Your drinking has increased.
         2. You are having panic attacks.
         3. You are very fearful about getting killed in Iraq.

  During your discussion, he/she tells the First Sgt.: “I can’t go on this
  deployment. I will do whatever it takes not to deploy.”




G-1, Human Resources Policy Directorate                                             3 September 2008   2
                                 Scenario #1 – Pre-deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                                 STRATEGIC QUESTIONS:
    1. How could you have prepared your troops such that they do not
       experience excessive anxiety about deploying?
    2. What resources are available to you to help prepare your unit?
    3. What conditions would have to exist for YOU to seek services
       through the Community Mental Health Service. Do those conditions
       exist for your Soldiers?
    4. How do you encourage Soldiers to appropriately seek mental health
       services, and how do you reduce any stigma regarding the use of
       such services?
    5. You have been told your suicide rate is unacceptable. How do you
       go about reducing suicides in your unit?




G-1, Human Resources Policy Directorate                                             3 September 2008   3
                                 Scenario #1 – Pre-deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                STRATEGIC QUESTIONS and ANSWERS:
    1. How could you have prepared your troops such that they do not experience
       excessive anxiety about deploying? (use BATTLEMIND, create an environment
       that fosters help-seeking; eliminate policies and procedures which inadvertently
       punish soldiers for seeking assistance; assume responsibility for the mental health of
       your Soldiers; monitor Soldier access to needed services).
    2. What resources are available to you to help prepare your unit? (Community
       Mental Health Service, Brigade mental health assets, medics, your chain-of-
       command; combat stress control; chaplains, your NCO’s and junior officers).
    3. What conditions would have to exist for YOU to seek services through the
       Community Mental Health Service. Do those conditions exist for your Soldiers?
       (For discussion).
    4. How do you encourage Soldiers to appropriately seek mental health services,
       and how do you reduce any stigma regarding the use of such services?
       (counseling from the top down; education regarding mental health services; creating
       realistic attitudes about services; creating a supportive atmosphere in which Soldiers
       know they can express their problems and seek help without negative
       consequences).
    5. You have been told your suicide rate is unacceptable. How do you go about
       reducing suicides in your unit? (know your Soldiers and have squad and platoon
       leaders know their Soldiers; solicit feedback from your Soldiers regarding their
       stressors; create a supportive environment where Soldiers feel comfortable talking
       with their leaders about the problems they are experiencing; training regarding the
       identification of individuals who may be at risk; consult with your mental health
       resources; emphasis on the buddy system; early intervention).



G-1, Human Resources Policy Directorate                                             3 September 2008   4
                                 Scenario #1 – Pre-deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                                  TACTICAL QUESTIONS:
    1. What should you do once the Soldier states he is willing to do
       anything to avoid deployment?
    2. If you suspect the Soldier is malingering, what should you do?
    3. Why should you not just confront the Soldier by telling him his
       threats are bogus?
    4. What risk factors has this Soldier demonstrated (even though not
       necessarily known by the chain-of-command)?
    5. What types of “suicide precautions” should you have in place for
       suicidal Soldiers who are not hospitalized?




G-1, Human Resources Policy Directorate                                             3 September 2008   5
                                 Scenario #1 – Pre-deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                   TACTICAL QUESTIONS and ANSWERS:
    1. What should you do once the Soldier states he is willing to do anything to
       avoid deployment? (Ask him if he is considering suicide as a possible alternative. If
       he says “No”, do not assume he is answering honestly. Probe more deeply; ask more
       questions regarding his possible intent and plan. If the Soldier says “Yes”, remain
       calm. Care for the Soldier by removing any means to harm him. Escort the Soldier to
       the nearest behavioral health provider or chaplain. Do not leave the Soldier alone.)
    2. If you suspect the Soldier is malingering, what should you do? (Regard it as a
       true incident of suicidal behavior. Let the mental health providers determine the best
       way to manage this Soldier. Inform your chain-of-command.)
    3. Why should you not just confront the Soldier by telling him his threats are
       bogus? (Such confrontation violates all the principles of caring for a person with
       suicidal thought. You might actually drive the person into making a gesture or actually
       committing suicide. You are punishing the Soldier for expressing his thoughts and
       feelings and, if he ever does become truly suicidal, he may not express his intent the
       next time.)
    4. What risk factors has this Soldier demonstrated (even though not necessarily
       known by the chain-of-command)? (Increased anxiety increased drinking, panic
       attacks, increased fear; irrational thinking and impaired problem-solving abilities.)
    5. What types of “suicide precautions” should you have in place for suicidal
       Soldiers who are not hospitalized? (removal of the means to kill him/herself; unit
       watch; restriction to base; genuine care and concern from the chain-of-command).




G-1, Human Resources Policy Directorate                                             3 September 2008   6
                                 Scenario #1 – Pre-deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                              OPERATIONAL QUESTIONS:
     1. How does one distinguish between malingerers and those Soldiers
        with bona fide mental health problems?
     2. After speaking with this Soldier, he refuses to go to the Community
        Mental Health Service, the hospital, or the Chaplain’s office. What
        should you do next?
     3. This soldier, who lives off-post, fails to report for the morning
        formation. What should be done?
     4. This is the third or fourth time this Soldier has gone AWOL. Each
        time he/she returned a few days later. The current sequence of
        events seems to be falling in line with his/her typical way of reacting
        to pressure. How should you, as this Soldier’s leader, respond?
     5. After he/she fails to report for morning formation and fails to respond
        to telephone calls, you go to the Soldier’s house only to find him/her
        drunk and in his/her bed. During your conversation with the Soldier,
        he/she states that getting drunk is the only way he/she can avoid the
        “panic attacks”. What would be your best course of action?



G-1, Human Resources Policy Directorate                                             3 September 2008   7
                                  Scenario #1 – Pre-deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired


            OPERATIONAL QUESTIONS and ANSWERS:
     1.   How does one distinguish between malingerers and those Soldiers with bona fide mental health
          problems? (It is not possible to predict completed suicide at the individual level. One can only identify
          individuals who are at risk. Never assume that someone is malingering, even if their threats appear
          bogus.)
     2.   After speaking with this Soldier, he refuses to go to the Community Mental Health Service, the
          hospital, or the Chaplain’s office. What should you do next? (Remain calm; explore the Soldier’s
          fear of seeing a mental health professional; if he still refuses, you, you and another unit member, and/or
          military police must escort the Soldier to the nearest mental health care provider, whether that is a
          brigade asset, a Community Mental Health Service, or the hospital emergency room; do not leave the
          Soldier alone.)
     3.   This soldier, who lives off-post, fails to report for the morning formation. What should be done?
          (Make no assumptions. Try to telephone the Soldier. If the Soldier is married, try to contact his/her
          spouse. Talk with others to see if the Soldier discussed his/her plans with them If unable to reach the
          Soldier and/or his/her spouse telephonically, go to his/her house Notify your chain-of-command. Without
          disturbing the scene, look for other signs of possible intent: Is his/her automobile there? Are electrical
          appliances turned on? Discuss with your chain-of-command the necessity to contact civil authorities.)
     4.   This is the third or fourth time this Soldier has gone AWOL. Each time he/she returned a few days
          later. The current sequence of events seems to be falling in line with his/her typical way of
          reacting to pressure. How should you, as this Soldier’s leader, respond? (Even though the Soldier
          has a history of acting in a similar fashion, one cannot make assumptions. One must respond to this
          situation as if it were a true suicidal emergency. It is better to be safe than to be sorry. Also, people will
          frequently make several “gestures” before they finally kill themselves. This Soldier feels he/she has a
          problem for which there is no solution, and his/her repeated “gestures” are probably his/her best way to
          communicate their desperation. As a leader, your first step must be to ensure the Soldier’s safety. After
          that, you can assist them in formulating better solutions to their problems.)
     5.   After he/she fails to report for morning formation and fails to respond to telephone calls, you go
          to the Soldier’s house only to find him/her drunk and in his/her bed. During your conversation
          with the Soldier, he/she states that getting drunk is the only way he/she can avoid the “panic
          attacks”. What would be your best course of action? (While it would be easy to dismiss the Soldier’s
          complaints as “excuses”, one must leave diagnosis for the professionals. Since the Soldier is obviously
          intoxicated, you should report to your chain-of-command and escort the Soldier to the emergency room.)


G-1, Human Resources Policy Directorate                                                        3 September 2008     8
                              Scenario #2 – Warrior in Transition
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired


  SFC Rodriguez was a 39 year old, married, Hispanic male, who deployed to Iraq in 2006.
  Since his return in 2007, he has been in constant trouble with his unit. However, his unit
  has been generally very tolerant of his behavior. He was perceived by the command and
  fellow Soldiers as a hero. While on patrol in Iraq, SFC Rodriguez stopped a suicide
  bomber from entering his unit’s area of operation. He spotted an intruder running towards
  his patrol. He yelled “Halt!” at the intruder; however, the person kept running in his
  direction. When he realized the individual was not going to stop, he opened fire, killing
  the intruder. The insurgent fell to the ground, setting off an IED. SFC Rodriguez was hit
  by shrapnel and rendered unconscious. At the time, he was diagnosed with mild
  traumatic brain injury. He received an ARCOM with valor and was credited with saving
  the lives of many fellow soldiers.
  Since his return from IRAQ, SFC Rodriguez has begun to abuse alcohol. His drinking has
  had a negative effect on his marriage, and he has twice been referred to the Family
  Advocacy Program for spouse abuse. During one week-end drinking binge, he was
  involved in a motor vehicle accident which caused some minor injuries. He has been
  referred to the Behavioral Health and the Drug and Alcohol treatment programs, where
  he was diagnosed with alcohol dependence and depression. Given his diagnosis he has
  been provided with medications to improve his mood. Because of his continued
  nightmares, sleep problems, irritability, and frequent flashbacks to the IED event, he was
  finally diagnosed with posttraumatic stress disorder. In the Fall of 2007, he was referred
  to the Warrior Transition Unit for treatment and monitoring. He is to be medically
  discharged from the Army.
  Shortly after being assigned to the Warrior Transition Unit, SFC Rodriguez got into
  another argument with his wife, accusing her of infidelity. During that argument, he
  threatened to kill himself. At this point, his wife became very concerned and decided to
  seek the help of a neighbor. When his wife returned, SFC Rodriguez was sitting on the
  bed holding his pistol. Mrs. Rodriguez called the MP’s and the WTU caseworker, who
  persuaded SFC Rodriguez to give them his weapon. He was eventually seen by
  Behavioral Health in the hospital emergency room.
G-1, Human Resources Policy Directorate                                             3 September 2008   9
                              Scenario #2 – Warrior in Transition
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                                 STRATEGIC QUESTIONS:
    1. Is the present system of screening Soldiers upon their return from
       theater adequate? Why or why not?
    2. What can be done within the Army to detect troubled Soldiers
       earlier, since early intervention works best by preventing a
       downward spiraling cycle of negative behaviors?
    3. There are those who say that suicide prevention programs are a
       waste of money since suicide occurs so infrequently, since it is
       virtually impossible to predict actual suicide, and since there are
       larger issues to address. These same people feel that the suicide
       prevention program is largely a public relations response to a series
       of sensitive issues, such as the conditions at Walter Reed, the lack
       of adequate armor in theater, the return of thousands of severely
       injured Soldiers, etc. Do you feel suicide is an important issue to be
       addressing? Why or why not?
    4. Has the Army’s decision to take in a lager proportion of Category
       IV’s affected the incidence of suicide? If so, how?
    5. Even though it might increase challenges to recruiting goals, do you
       think a pre-enlistment screening for psychological stamina and
       mental health should be implemented? Why or why not?

G-1, Human Resources Policy Directorate                                             3 September 2008   10
                              Scenario #2 – Warrior in Transition
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

               STRATEGIC QUESTIONS and ANSWERS:
    1. Is the present system of screening Soldiers upon their return from theater
       adequate? Why or why not? (any self-report is dependent upon the
       willingness of the Soldier to admit to problems; a Command climate free of
       stigma increases the effectiveness of the screening program).
    2. What can be done within the Army to detect troubled Soldiers earlier,
       since early intervention works best by preventing a downward spiraling
       cycle of negative behaviors? (There is no single correct answer.)
    3. There are those who say that suicide prevention programs are a waste of
       money since suicide occurs so infrequently, since it is virtually impossible
       to predict actual suicide, and since there are larger issues to address.
       These same people feel that the suicide prevention program is largely a
       public relations response to a series of sensitive issues, such as the
       conditions at Walter Reed, the lack of adequate armor in theater, the return
       of thousands of severely injured Soldiers, etc. Do you feel suicide is an
       important issue to be addressing? Why or why not? (No single correct
       answer.)
    4. Has the Army’s decision to take in a lager proportion of Category IV’s
       affected the incidence of suicide? If so, how? (It has been demonstrated that
       mental health is correlated to a significant degree with intelligence. Those
       individuals with low scores frequently bring mental health problems with them
       when they enlist.)
    5. Even though it might increase challenges to recruiting goals, do you think
       a pre-enlistment screening for psychological stamina and mental health
       should be implemented? Why or why not? (No single correct answer.)

G-1, Human Resources Policy Directorate                                             3 September 2008   11
                                Scenario #2 – Warrior in Transition
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                                  TACTICAL QUESTIONS:
    1. SFC Rodriguez left a trail of indications that he was having
       significant problems. List the various warning signs displayed by
       SFC Rodriguez in this scenario.
    2. At what point in time could SFC Rodriguez have been helped most
       effectively?
    3. Whose responsibility was it to identify SFC Rodriguez as being at
       risk for suicide?
    4. SFC Rodriguez has now been successfully treated and has been
       returned to duty. What steps can you take to help him reintegrate
       into the unit and reassume his former position?
    5. As a leader, would you have handled the situation differently had the
       soldier been a PFC with only one year of service? Why or why not?




G-1, Human Resources Policy Directorate                                             3 September 2008   12
                                Scenario #2 – Warrior in Transition
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                   TACTICAL QUESTIONS and ANSWERS:
    1. SFC Rodriguez left a trail of indications that he was having significant
       problems. List the various warning signs displayed by SFC Rodriguez in
       this scenario. (mild traumatic brain injury with loss of consciousness; alcohol
       abuse/dependence resulting in a motor vehicle accident; behaviors leading to
       referrals to the Family Advocacy Program, Behavioral Health, and the
       Substance Abuse Treatment Program; depression requiring medications;
       reports of continued nightmares and other sleep problems; his reports of
       frequent flashbacks; marital problems)

    2. At what point in time could SFC Rodriguez have been helped most
       effectively? (At the first sign of behavioral/emotional problems)

    3. Whose responsibility was it to identify SFC Rodriguez as being at risk for
       suicide? (everyone’s)

    4. SFC Rodriguez has now been successfully treated and has been returned
       to duty. What steps can you take to help him reintegrate into the unit and
       reassume his former position?(discussion, there is no single right answer.)

    5. As a leader, would you have handled the situation differently had the
       soldier been a PFC with only one year of service? Why or why not? (the
       answer should be no; one cannot make judgments about or put a value on
       human lives; all Soldiers should be managed fairly and humanely).

G-1, Human Resources Policy Directorate                                             3 September 2008   13
                              Scenario #2 – Warrior in Transition
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                              OPERATIONAL QUESTIONS:
     1. Describe how the ACE intervention model was applied in this case.
     2. After seeing a mental health professional, SFC Rodriguez is
        admitted to the hospital. What should be your course of action?
     3. SFC Rodriguez has been released from the hospital and returned
        to the WTU, where he is being processed for a medical discharge.
        Does this end your responsibility to this Soldier?
     4. As SFC Rodriguez’s first-line supervisor, what if anything do you do
        for Mrs. Rodriguez?
     5. After one-year on TDRL, SFC Rodriguez has successfully dealt
        with his problems and has been pronounced fit to return to duty. In
        fact, he is being reassigned back to your unit. How do you assist
        SFC Rodriguez in reintegrating back into the unit?




G-1, Human Resources Policy Directorate                                             3 September 2008   14
                               Scenario #2 – Warrior in Transition
           Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired


           OPERATIONAL QUESTIONS and ANSWERS:
1. Describe how the ACE intervention model was applied in this case. (since the Soldier is
   obviously suicidal, immediate action was taken; caring was demonstrated verbally and by removing
   the weapon; the Soldier was escorted to the emergency room where he could get assistance)
2. After seeing a mental health professional, SFC Rodriguez is admitted to the hospital. What
   should be your course of action? (Maintain unit contact with the Soldier; express genuine
   sympathy; reward the Soldier verbally for being wise enough to seek assistance; assure the Soldier
   that he will be welcome once he returns to the unit; ask if there is anything you can help him with
   while he is in the hospital.)
3. SFC Rodriguez has been released from the hospital and returned to the WTU, where he is
   being processed for a medical discharge. Does this end your responsibility to this Soldier?
   (legally, yes. Morally and ethically there is less agreement. This Soldier has served your Army well for
   many years. To break off all contact and, in effect, ostracize him for having negative feelings will
   probably generate some degree of resentment on his part. Demonstrate to SFC Rodriguez that his
   contributions are remembered and valued. Maintain contact with SFC Rodriguez until, and perhaps
   even after, his discharge. If possible, assist him in his transition to civilian life. It is remarkable what an
   effect small kindnesses, such as sending a card a couple of times per year, can have.).
4. As SFC Rodriguez’s first-line supervisor, what if anything do you do for Mrs. Rodriguez? (Mrs.
   Rodriguez has been an important part of the Army for a long time, and she deserves some
   assistance. Talk with her regarding any problems she is having and advise her of resources available
   to her both on-base and in the civilian community. Assure her that you are available if needed. The
   Golden Rule applies in many situations).
5. After one-year on TDRL, SFC Rodriguez has successfully dealt with his problems and has
   been pronounced fit to return to duty. In fact, he is being reassigned back to your unit. How do
   you assist SFC Rodriguez in reintegrating back into the unit? (First, assure SFC Rodriguez of
   your continued support. Reward him for his successful rehabilitation. Whenever the chance arises,
   demonstrate your confidence in SFC Rodriguez’ abilities and judgment. Do not feel you must handle
   him gently; allow him to be the healthy adult he indeed is. It is very likely that, because of his
   experiences, SFC Rodriguez will come back a stronger and healthier person than before. It is likely
   that, because of his experiences, he will be a more understanding and compassionate leader.)
 G-1, Human Resources Policy Directorate                                               3 September 2008   15
                                   Scenario #3 – Deployed Female
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired



  You are a twenty four year old, active duty Specialist. You are three months
  into your first deployment to theater. Your husband of three years sends you a
  text message requesting a divorce. He ends the message with, “…I am sorry…I
  didn’t expect to fall in love with someone else.”

  You are talking to a fellow NCO about this situation.
  She does not know:
           1. Your husband has a history of being unfaithful.
           2. Your husband previously requested a divorce. In response, you
              attempted suicide.

  You composed a text message to your husband stating that you will die if he
  divorces you.

  You are now having thoughts of killing yourself using your rifle.
  In talking with your fellow NCO you state, “My husband wants to divorce me; I
  can’t stand being here; If I were home, I could change his mind.”




G-1, Human Resources Policy Directorate                                             3 September 2008   16
                                Scenario #3 – Deployed Female
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                                 STRATEGIC QUESTIONS:
 1. How does one manage relationship problems that have the potential of
    impacting mission accomplishment?
 2. What support personnel/offices has Command made available to this
    Soldier and to other Soldiers?
 3. In some cases, one suicide has reportedly set off a “cluster” of other
    suicides. What mechanisms would you put in place to prevent a cluster of
    suicides/suicide attempts?
 4. How will you determine the success or failure of suicide prevention
    measures you have implemented?
 5. The suicide rate of your unit has consistently been higher than other units
    at the same echelon, even though you have implemented a suicide
    prevention program. What steps can you take to change this situation?




G-1, Human Resources Policy Directorate                                             3 September 2008   17
                                Scenario #3 – Deployed Female
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

              STRATEGIC QUESTIONS and ANSWERS:
 1. How does one manage relationship problems that have the potential of impacting
    mission accomplishment? Is it Command’s job to concern themselves with such
    problems? Within the command, who is best suited to address such problems? (Yes,
    anything that impacts unit performance is a concern of Commanders. The NCO staff appears
    best suited to identify and monitor such problems, making appropriate referrals when
    necessary.)
 2. What support personnel/offices has Command made available to this Soldier and to
    other Soldiers? (Community Mental Health; Combat Stress Team; Brigade Psychologist’s
    office; her chain-of-command; chaplains, JAG; possibly others).
 3. In some cases, one suicide has reportedly set off a “cluster” of other suicides. What
    mechanisms would you put in place to prevent a cluster of suicides/suicide attempts?
    (the most effective mechanism is a trained and sensitive chain-of-command that effectively
    and efficiently communicates information upwards and downwards; the entire chain-of-
    command must be genuinely caring and supportive, even if individuals feel they are being
    manipulated; one could ask chaplains and/or mental health experts to come into the
    organization and present frank information regarding suicide).
 4. How will you determine the success or failure of suicide prevention measures you
    have implemented? (Command climate surveys; Battlemind survey; Behavioral Health
    Needs Assessment survey).
 5. The suicide rate of your unit has consistently been higher than other units at the same
    echelon, even though you have implemented a suicide prevention program. What
    steps can you take to change this situation? (consult with your chain-of-command;
    consult with other leaders at the same echelon to determine what differences exist between
    your and their units; consult with behavioral health specialists; survey your unit regarding
    individual stressors and stressors that affect the entire unit; ensure that your chain of
    command is knowledgeable about, and sensitive to, behaviors which can signal potential
    suicidal thought).
G-1, Human Resources Policy Directorate                                             3 September 2008   18
                                Scenario #3 – Deployed Female
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                       TACTICAL QUESTIONS:
    1. As a unit Commander, do you want to take this Soldier into
       combat? Why or why not?
    2. You refer the Soldier for a mental status evaluation. The
       provider responds that the SPC is not currently at a high-risk for
       suicide. However, the provider also recommends unit watch and
       follow-up treatment at the mental health center. What should
       your course of action be?
    3. What are the pros and cons of the various administrative actions
       available to you regarding this Soldier, such as chapter action
       versus limited duty versus medivac/hospitalization versus return
       to full duty?
    4. Many of your Soldiers could have marital problems. Many of
       them will handle the situation well. Others may become suicidal.
       Still others may not talk about it. We call the difference between
       those who handle such stress well and those who do not
       “resilience”. Are there things you can do to build resilience within
       your unit?
    5. At what point should Command begin to think in terms of a
       chapter action or medical board for suicidal Soldiers?
G-1, Human Resources Policy Directorate                                             3 September 2008   19
                                      Scenario #3 – Deployed Female
               Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                       TACTICAL QUESTIONS and ANSWERS:
1.     As a unit Commander, do you want to take this Soldier into combat? Why or why not? (There is no correct
       answer. For discussion)
2.     You refer the Soldier for a mental status evaluation. The provider responds that the SPC is not currently at a
       high-risk for suicide. However, the provider also recommends unit watch and follow-up treatment at the
       mental health center. What should your course of action be? (Discuss the Soldier’s condition telephonically or
       face-to-face with the provider so that you are clear regarding the Soldier’s mental health status and so you and the
       provider can assist each other in helping the Soldier. Resolve, to your satisfaction, the seemingly contradictory
       recommendations of the mental health provider [i.e. Not at a high risk for suicide but, nevertheless, placed on unit
       watch.]).
3.     What are the pros and cons of the various administrative actions available to you regarding this Soldier,
       such as chapter action versus limited duty versus medivac/hospitalization versus return to full duty? (Ideally,
       using the various resources available to you, you will ultimately be able to return this Soldier to full duty. Many mental
       health providers are reluctant to hospitalize Soldiers, because few such Soldiers return to make the contributions they
       are capable of and, thus, are frequently medically boarded out of the Army. Such an action causes manpower
       shortages within the unit and probably leads to further, more long-term psychological problems for the Soldier
       following discharge. The best place for treatment of the suicidal Soldier is within his/her unit. However, such “within-
       unit treatment” makes many Commanders uncomfortable. Commanders also frequently feel that such “within-unit
       treatment” saps the unit’s strength. If at all possible, return the Soldier to limited duty as quickly as possible, in
       conjunction with mental health provider recommendations, followed by a return to full duty once the crisis is resolved.
       Such a course of action meets Army treatment conditions of immediacy, proximity, and brevity. Unfortunately, many
       Commanders are quick to chapter who cause problems, and many mental health care providers are eager to comply
       with the Commanders’ decisions. In an era where enlistment standards have been lowers and where the Army is
       having trouble filling its ranks, such a “quick draw” on chapter actions is not without negative consequences, for both
       the Army and the Soldier in question.)
4.     Many of your Soldiers could have marital problems. Many of them will handle the situation well. Others may
       become suicidal. Still others may not talk about it. We call the difference between those who handle such
       stress well and those who do not “resilience”. Are there things you can do to build resilience within your
       unit? (Yes. Use BATTLEMIND and create an atmosphere wherein individuals feel free to talk about their problems
       without fear of reprisal or ridicule.)
5.     At what point should Command begin to think in terms of a chapter action or medical board for suicidal
       Soldiers? (When it is determined that the Soldier’s problems are of sufficient severity and chronicity that the Soldier’s
       ability to perform his/her job is significantly impaired; when it is determined that the Soldier’s behaviors constitute a
       realistic threat to others; and/or when it can be determined with a reasonable degree of certainty that the Soldier
       cannot be rehabilitated.).

     G-1, Human Resources Policy Directorate                                                       3 September 2008     20
                                Scenario #3 – Deployed Female
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                              OPERATIONAL QUESTIONS:
   1. What is the first thing the fellow NCO in this scenario should do?
   2. The Soldier denies feeling suicidal. What should her fellow NCO do
      now?
   3. The fellow NCO finds out that the Soldier is entertaining thoughts of
      suicide. What should she do now?
   4. What factors place this Soldier at a higher than normal risk for
      suicide?
   5. What factors serve to protect this Soldier?




G-1, Human Resources Policy Directorate                                             3 September 2008   21
                                Scenario #3 – Deployed Female
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

         OPERATIONAL QUESTIONS and ANSWERS:
  1. What is the first thing the fellow NCO in this scenario should do?
     (express concern and ask if the Soldier is feeling suicidal).

  2. The Soldier denies feeling suicidal. What should her fellow NCO do
     now? (keep exploring to make sure the Soldier is not denying her
     feelings or is too embarrassed to discuss her situation).

  3. The fellow NCO finds out that the Soldier is entertaining thoughts
     of suicide. What should she do now? (express caring and concern
     and take away the Soldier’s rifle; then she should escort the Soldier to
     the appropriate mental health facility and/or someone higher in her
     chain-of-command; the Soldier should never be left alone).

  4. What factors place this Soldier at a higher than normal risk for
     suicide? (a previous attempt; a failing relationship; feelings of
     powerlessness).

  5. What factors serve to protect this Soldier? (she is not keeping her
     problems secret. In fact, she appears to be asking for help).

G-1, Human Resources Policy Directorate                                             3 September 2008   22
                                Scenario #4 – Post-Deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired


  John is a thirty year old Specialist in the National Guard. He has just returned from
     his first deployment in Afghanistan. During this deployment, he received an
     article 15 for insubordination. John just discovered that his girlfriend has been
     unfaithful and no longer wants to see him. He was very embarrassed by the
     article 15, and now he is feeling quite sad about losing his girlfriend.

  He is talking to a fellow Soldier.

  What the fellow Soldier does not know:
     1. John is feeling sad and taking medication to help him sleep.
     2. Until the article 15, John wanted to make the Army his career.
     3. John has been diagnosed with depression in the past.
     4. He is feeling like he did three years ago, when he tried to kill himself.
     5. He is considering killing himself by overdosing on sleeping pills.

  Sometime during the conversation John says, “I can’t take it any more.”




G-1, Human Resources Policy Directorate                                             3 September 2008   23
                                Scenario #4 – Post-Deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                                 STRATEGIC QUESTIONS:
    1. Do Guardspersons and Reservists have any special needs that
       must be considered as part of your suicide prevention program?
    2. As a Commander, would you permit your unit to be used as subjects
       in research into suicide prevention? Why or why not?
    3. Are increasing suicide rates a part of the “unraveling” of the Army
       spoken of by Gen. (Ret.) Barry McCaffrey? Why or why not?
    4. Do you believe that suicide prevention is not as important in an
       organization based on a Warrior ethos? Why or why not?
    5. As a leader, do you feel you have a moral, ethical, or legal obligation
       to your Soldiers and, by extension, to the safety of your Soldiers?
       Why or why not?




G-1, Human Resources Policy Directorate                                             3 September 2008   24
                                Scenario #4 – Post-Deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

             STRATEGIC QUESTIONS and ANSWERS:
    1. Do Guardspersons and Reservists have any special needs that must be
       considered as part of your suicide prevention program? (necessity to readjust
       from civilian to military and back to civilian; financial pressures are different)

    2. As a Commander, would you permit your unit to be used as subjects in
       research into suicide prevention? Why or why not? (for discussion; much more
       research is needed to truly understand suicide and the prevention of suicide.)

    3. Are increasing suicide rates a part of the “unraveling” of the Army spoken of
       by Gen. (Ret.) Barry McCaffrey? Why or why not? (Many people see increasing
       suicide rates as but one indication of systemic distress; other indicators include the
       increasing loss of NCO’s and company grade officers; the need to significantly
       increase enlistment incentives, etc.)

    4. Do you believe that suicide prevention is not as important in an organization
       based on a Warrior ethos? Why or why not? (preventing suicidal behavior is part
       of the warrior ethos – never leave a fallen comrade; some service members may not
       have actually embraced the warrior ethos).

    5. As a leader, do you feel you have a moral, ethical, or legal obligation to your
       Soldiers and, by extension, to the safety of your Soldiers? Why or why not?
       (people are more than expendable items or “human capital”, they are human beings
       with the same desire to live as you; you certainly have a moral and ethical obligation
       to your Soldiers, even in spite of the Ferres doctrine; an argument for a legal
       obligation could be made in cases involving dereliction of duty.)
G-1, Human Resources Policy Directorate                                             3 September 2008   25
                                Scenario #4 – Post-Deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                                  TACTICAL QUESTIONS:
    1. You get the feeling that the Soldier is using his circumstances to
       obtain some special treatment from Command. What should you
       do?
    2. John explains that he does not want to go to behavioral health or the
       chaplain, because his peers would view him as weak. What should
       you do?
    3. How do you determine if John is having thoughts of suicide?
    4. John confides to his friend that he is indeed feeling depressed and
       suicidal and that he is considering taking an overdose. What should
       his friend do next?
    5. After removing the pills, what should the friend and chain-of-
       command do next?




G-1, Human Resources Policy Directorate                                             3 September 2008   26
                                Scenario #4 – Post-Deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                TACTICAL QUESTIONS and ANSWERS:
    1. You get the feeling that the Soldier is using his circumstances to obtain some
       special treatment from Command. What should you do? (do nothing; refer the
       Soldier to mental health and wait for a mental health provider to make a diagnosis; do
       not be judgmental).

    2. John explains that he does not want to go to behavioral health or the chaplain,
       because his peers would view him as weak. What should you do? (Explain that it
       takes courage to deal with one’s problems, and that you are impressed that he had
       the strength to discuss his problems with you. Next, insist that John see a behavioral
       health specialist or a chaplain. If John continues to refuse, have him escorted to the
       emergency room.)

    3. How do you determine if John is having thoughts of suicide? (Ask him directly.
       Ask him if he has an idea how he would do it. Ask if he has medications available to
       him. Ask if he has ever tried suicide before.)

    4. John confides to his friend that he is indeed feeling depressed and suicidal and
       that he is considering taking an overdose. What should his friend do next?
       (Without leaving John alone, he should notify the chain-of-command, who in turn
       should demonstrate caring by confiscating the medicine bottles.)

    5. After removing the pills, what should the friend and chain-of-command do
       next? (John should be escorted to the Community Mental Health Service or, after
       hours, the emergency room.)


G-1, Human Resources Policy Directorate                                             3 September 2008   27
                                Scenario #4 – Post-Deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                             OPERATIONAL QUESTIONS:
    1. What are the two major factors that place this Specialist at a higher
       than normal risk for suicide?
    2. What should be your first response to his statement, “I can’t take it
       any more”?
    3. While talking to this Soldier, you start to feel very uncomfortable and
       doubt your abilities to be very helpful. What would be your best
       course of action?
    4. This Soldier agrees to speak with you only if your promise not to tell
       anyone else. What should you do?
    5. Do you think John is actually suicidal? Why or why not?




G-1, Human Resources Policy Directorate                                             3 September 2008   28
                                Scenario #4 – Post-Deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

      OPERATIONAL QUESTIONS and ANSWERS:
    1. What are the two major factors that place this Specialist at a higher
       than normal risk for suicide? (previous attempt; distressing life events).

    2. What should be your first response to his statement, “I can’t take it
       any more”? (Ask if he has been having thoughts about suicide.)

    3. While talking to this Soldier, you start to feel very uncomfortable and
       doubt your abilities to be very helpful. What would be your best
       course of action? (Without leaving the Soldier alone, notify your chain-of-
       command.)

    4. This Soldier agrees to speak with you only if your promise not to tell
       anyone else. What should you do? (Explain that you cannot make such a
       promise. If he refuses to continue, escort him to your supervisor or to a
       mental health professional).

    5. Do you think John is actually suicidal? Why or why not? (There can be
       a variety of responses. However, it is important to note that the proper
       people to make this determination are mental health providers.)



G-1, Human Resources Policy Directorate                                             3 September 2008   29
                                 Scenario #5 – Pre-deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired



    You are the First Sergeant of a unit. A twenty year-old active duty PVT (E2) is
    preparing for her first deployment to Iraq. She recently received an Article 15
    for being AWOL. She tells you that her husband has “maxed out” the credit
    cards, and that the bank is threatening to start foreclosure proceedings if she
    does not make an immediate house payment. She is feeling quite powerless
    and overwhelmed.

    What you do not know:
        1. The PVT has been fighting daily with her husband about the finances.
        2. Her drinking has increased.
        3. She just increased the amount of death benefits on her insurance.
        4. She has been thinking about volunteering for any dangerous mission to
           end her life.

    During your discussion with her, she tells you: “I love my husband, and I have a
    plan to make sure he is taken care of when I’m gone.”




G-1, Human Resources Policy Directorate                                             3 September 2008   30
                                 Scenario #5 – Pre-deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                                STRATEGIC QUESTIONS:
    1. Do you think that current suicide prevention strategies are presented
       to all concerned constituencies (i.e. Guard, Reserves)?
    2. Given all the required training and classes Soldiers must receive
       before being deployed, do you think the suicide prevention message
       gets lost in the “noise?” Why or why not?
    3. If you think the message is getting lost, how do you improve the
       “signal to noise ratio”?
    4. What factors do you think contribute to the increase in the Army’s
       suicide rate when compared to that of other services?
    5. If you were the Army Surgeon General, what kind of suicide
       prevention measures would you put in place other than educational
       classes and the “buddy system”?




G-1, Human Resources Policy Directorate                                             3 September 2008   31
                                 Scenario #5 – Pre-deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

               STRATEGIC QUESTIONS and ANSWERS:
    1. Do you think that current suicide prevention strategies are presented
       to all concerned constituencies (i.e. Guard, Reserves)? Why or why
       not? (there is no single correct answer; for discussion).

    2. Given all the required training and classes Soldiers must receive
       before being deployed, do you think the suicide prevention message
       gets lost in the “noise?” Why or why not? (there is no single correct
       answer; for discussion).

    3. If you think the message is getting lost, how do you improve the
       “signal to noise ratio”? (there is no single correct answer; for discussion).

    4. What factors do you think contribute to the increase in the Army’s
       suicide rate when compared to that of other services? (numerous
       factors may be identified such as lowered recruiting standards; optemps,
       extension of tours, inadequate time for rest and recovery; prior unavailability
       of resources to assist Soldiers in transitioning back to a garrison mentality
       and then back to a theater mentality, etc.).

    5. If you were the Army Surgeon General, what kind of suicide prevention
       measures would you put in place other than educational classes and
       the “buddy system”? (for discussion)

G-1, Human Resources Policy Directorate                                             3 September 2008   32
                                 Scenario #5 – Pre-deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                                  TACTICAL QUESTIONS:
    1. Do you have any suspicions that this PVT may be suicidal? If so,
       why?

    2. How would you determine whether or not she is a danger to herself
       or others?
    3. Your unit is due to deploy in two weeks. Do you want to take this
       Soldier with you? Why or why not?
    4. After a few days of counseling at the Community Mental Health
       Service and consultations with JAG, Army Emergency Relief, and a
       credit management agency, the PVT announces that she is feeling
       much better and wishes to deploy with the unit. The mental health
       provider informs you, via your request for a mental status
       examination, that the Soldier is fit for duty. What do you do?

    5. You decide that the PVT will deploy with you. Once you in theater,
       however, she volunteers for some very hazardous tasks. What do
       you make of this, and how do you respond?




G-1, Human Resources Policy Directorate                                             3 September 2008   33
                                 Scenario #5 – Pre-deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                TACTICAL QUESTIONS and ANSWERS:
    1. Do you have any suspicions that this PVT may be suicidal? If so, why? (her relative
       youth; perhaps some anxiety about deploying and leaving her family; recent nonjudicial
       punishment; financial distress, reference to potential non-being, i.e. death).
    2. How would you determine whether or not she is a danger to herself or others? (Ask; if
       unsure, escort to mental health provider if necessary).
    3. Your unit is due to deploy in two weeks. Do you want to take this Soldier with you?
       Why or why not? (With proper treatment, suicidal ideation can be rather fleeting in nature.
       Interventions addressing her financial status and alcohol consumption could produce
       positive results. Leaving her behind could be seen as rejection by her unit, causing her to
       feel weak, unwanted, and incompetent. On the other hand, deploying with her could also
       possibly result in overwhelming stress for her. This is a judgment call you will have to make.
       Be sure to consult with all those individuals who could help you make this decision).
    4. After a few days of counseling at the Community Mental Health Service and
       consultations with JAG, Army Emergency Relief, and a credit management agency,
       the PVT announces that she is feeling much better and wishes to deploy with the unit.
       The mental health provider informs you, via your request for a mental status
       examination, that the Soldier is fit for duty. What do you do? (the best course of action
       would probably be to sit and talk with the Soldier about her feelings then and now; ask her
       how she knows she is ready to deploy; ask about her home situation and whether or not her
       worries about her husband might cause her distress once overseas; based upon your
       judgment, you will decide whether or not she deploys; it would seem wise to speak with the
       mental health provider to learn the reasoning behind his recommendation).

    5. You decide that the PVT will deploy with you. Once you in theater, however, she
       volunteers for some very hazardous tasks. What do you make of this, and how do you
       respond? (again, it is essential to maintain good communication with the Soldier in order to
       determine the motivation for her volunteerism; if uncertain, request another consultation
       from a mental health provider)
G-1, Human Resources Policy Directorate                                             3 September 2008   34
                                 Scenario #5 – Pre-deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                             OPERATIONAL QUESTIONS:
    1. When the private states she has a plan to make sure her husband is
       taken care of when I’m gone, what should your response be?
    2. Why do you think it is important to ask a potentially suicidal individual
       about their substance use/abuse?
    3. What facts about this case suggest that the private is indeed
       suicidal?
    4. Are there any factors in this scenario which may serve to reduce
       suicide potential?
    5. The Soldier finally admits that she is experiencing significant marital
       distress. What importance do you attach to this fact?




G-1, Human Resources Policy Directorate                                             3 September 2008   35
                                 Scenario #5 – Pre-deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

          OPERATIONAL QUESTIONS and ANSWERS:
    1. When the private states she has a plan to make sure her husband is taken care of
       when I’m gone, what should your response be? (You should ask her directly what she
       means by that statement. Is she merely stating a fact, or is communicating suicidal
       thoughts? She might be giving a clue, wanting someone to rescue her. You might begin by
       asking her what her plan is. If you have any questions, contact your chain-of-command.)
    2. Why do you think it is important to ask a potentially suicidal individual about their
       substance use/abuse? (Drinking or taking drugs may increase the person’s impulsivity.
       Thus, they might commit suicide impulsively while intoxicated whereas they might not had
       they been sober. Also, an intoxicated Soldier would not be an appropriate referral to the
       Community Mental health Service. Rather, they should be escorted to the emergency
       room.)
    3. What facts about this case suggest that the private is indeed suicidal? (The fact that
       the private has recently been involved in disciplinary actions. She has financial problems for
       which she sees no solution. She has been told she may lose her house to foreclosure. She
       is also experiencing the stress associated with deploying for the first time. At home she
       experiences marital discord. She has increased her alcohol intake. She is in the process of
       preparing for her absence by increasing the death benefits on her insurance, and she states
       she wants to volunteer for hazardous assignments so she will be killed.)
    4. Are there any factors in this scenario which may serve to reduce suicide potential?
       (Yes, the Soldier is young and a female. Females make more suicidal “gestures” but these
       “gestures” are usually not as lethal as those made by males. There does not appear to be a
       history of suicide attempts. Furthermore, her wish to be killed on a hazardous mission
       seems to suggest that she is not imminently suicidal.)
    5. The Soldier finally admits that she is experiencing significant marital distress. What
       importance do you attach to this fact? (Relationship problems are involved in a large
       percentage of suicides. It is therefore important to question potentially suicidal individuals
       regarding their marriages/relationships.)
G-1, Human Resources Policy Directorate                                             3 September 2008    36
                                Scenario #6 – Deployed Captain
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired



    A 27 year-old, active duty Captain (O3) is in his third month of his second
    deployment. This deployment has brought back many painful memories from
    his first deployment. Up to this point in time, he has been able to cope with the
    memories. However, on a recent patrol, two guys in his unit were gunned down
    by insurgents. He failed to fire back at the enemy. Now that he is safely back in
    the rear area, he finds himself obsessed with this incident. He cannot
    understand why his men were killed but he is still alive.

    He is talking about the firefight with his boss, who does not know:
         1. He is struggling with recurrent, intrusive thoughts from his first
            deployment.
         2. He failed to fire back at the enemy during the firefight.
         3. He is feeling guilty about the deaths of his Soldiers.
         4. He now has frequent thoughts about joining his dead comrades.

    At some point in the conversation, he states “I should have died with my men.”




G-1, Human Resources Policy Directorate                                             3 September 2008   37
                                Scenario #6 – Deployed Captain
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                                STRATEGIC QUESTIONS:
    1. A lot of attention is given to the enlisted Soldier. Is equal attention
       given to the morale and welfare of junior officers? Why or why not?
    2. With all this attention on suicide prevention, what prevents Soldiers
       from exploiting “the S word” to their advantage in order to shirk duties
       or obligations?
    3. Where do you think behavioral health assets should be positioned?
    4. Since many suicides occur off-post, how do you, as a Commander,
       monitor suicide risk factors among Soldiers who do not reside in the
       barracks?
    5. Given the current OPTEMPS, what resources do you realistically
       have at your disposal to monitor the psychological status of your unit
       in order to prevent suicide?




G-1, Human Resources Policy Directorate                                             3 September 2008   38
                                Scenario #6 – Deployed Captain
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

               STRATEGIC QUESTIONS and ANSWERS:
    1. A lot of attention is given to the enlisted Soldier. Is equal attention given to the morale
       and welfare of junior officers? Why or why not? (For discussion).
    2. With all this attention on suicide prevention, what prevents Soldiers from exploiting
       “the S word” to their advantage in order to shirk duties or obligations? (The threat of
       suicide is one of a Soldier’s best tools for “manipulating the system.” For the less adapted
       Soldiers, there is nothing to stop such exploitation of medical services. If diagnosed as
       malingering, the SM could be subjected to a rather stiff penalty. However, malingering is
       difficult to diagnose. With Soldiers who fail to respond to any other motivation, UCMJ action
       is probably the best courses of action, with the understanding that such action might cause
       the SM to make some sort of gesture during which they might accidentally harm
       themselves. For better adapted Soldiers, unit cohesion, individual and group values, and
       recognition of the consequences of their behaviors will serve to avoid misuse of behavioral
       health resources).
    3. Where do you think behavioral health assets should be positioned? (there may be a
       variety of responses; however, generally speaking, such assets should be deployed as
       close to the action as possible, not back in an office in the rear).
    4. Since many suicides occur off-post, how do you, as a Commander, monitor suicide
       risk factors among Soldiers who do not reside in the barracks? (for discussion).
    5. Given the current OPTEMPS, what resources do you realistically have at your
       disposal to monitor the psychological status of your unit in order to prevent suicide?
       (a well-trained, sensitive NCO Corps and junior officers, behavioral health assets, combat
       stress control; chaplains, Command climate surveys; Battlemind surveys; Behavioral Needs
       Assessment Survey).



G-1, Human Resources Policy Directorate                                             3 September 2008   39
                                Scenario #6 – Deployed Captain
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                                  TACTICAL QUESTIONS:
    1. Is this officer at a low, medium, or high risk for suicide?.
    2. Do you think this officer’s PTSD and survivor’s guilt prevents him, in
       any way, of fully carrying out his duties? Why or why not?
    3. Assuming that, following treatment, this Captain returns to duty and
       proves himself to be an effective leader, do you think this incident
       should negatively impact his OER? Why or why not?
    4. In terms of maintaining his standing with his Soldiers, what do you
       think would be this Captain’s best course of action?
    5. Once an officer develops significant emotional problems, such as
       those demonstrated by this Captain, is he or she of any further use to
       the Army? Can an officer resume the position of authority he/she
       previously had? Why not just discharge all these people out of the
       service?




G-1, Human Resources Policy Directorate                                             3 September 2008   40
                                Scenario #6 – Deployed Captain
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                   TACTICAL QUESTIONS and ANSWERS:
    1. Is this officer at a low, medium, or high risk for suicide? (Low; in spite of some survivor’s guilt,
       posttraumatic stress disorder, and thoughts of death, there are no indications of imminent risk for
       suicide; however, this Captain should be encouraged to consult with a mental health specialist
       regarding his PTSD and survivor’s guilt).
    2. Do you think this officer’s PTSD and survivor’s guilt prevents him, in any way, of fully
       carrying out his duties? Why or why not? (the officer’s failure to fire his weapon during the
       encounter may be an indication that his judgment and/or attention may be compromised; consider
       mental health treatment possibly coupled with some rest and restoration).
    3. Assuming that, following treatment, this Captain returns to duty and proves himself to be an
       effective leader, do you think this incident should negatively impact his OER? Why or why
       not? (It is highly probably that this officer will be an asset to the Army. He should not be viewed as
       being “weak” or “sick” in any way. His PTSD and survivor’s guilt are normal reactions to an
       abnormal situation. In fact, his experiences may make him a more understanding leader.)
    4. In terms of maintaining his standing with his Soldiers, what do you think would be this
       Captain’s best course of action? (There may be a variety of responses. However, honest, self-
       disclosure appears to be the most effective response. Such a response might even elicit similar
       feelings from other members of his unit. There is no problem in being viewed as human).
    5. Once an officer develops significant emotional problems, such as those demonstrated by
       this Captain, is he or she of any further use to the Army? Can an officer resume the position
       of authority he/she previously had? Why not just discharge all these people out of the
       service? (These are decisions that must be made on a case-by-case basis; many people, upon
       resolution of their crisis, return to duty and prove to be highly effective Soldiers. One must also
       consider the effect any punishment or adverse action will have vis-à-vis stigma surrounding mental
       health services. One must also consider the Army’s shortage of junior officers and the impending
       shortage in senior leadership. The feelings that this Captain is experiencing are normal human
       reactions to an abnormal situation. If the Captain can successfully work through his problems,
       should he not be given the benefit of the doubt? Should this Captain’s career be ruined because he
       felt normal human emotions?).

G-1, Human Resources Policy Directorate                                                3 September 2008   41
                                Scenario #6 – Deployed Captain
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                             OPERATIONAL QUESTIONS:
    1. What would be the best response to the Captain’s statement, “I
       should have died with my men.”?
    2. How soon should the Captain be returned to his leadership position?
    3. Do you think this Captain is imminently suicidal? Why or why not?
    4. Does the fact that this Captain failed to return fire on the enemy after
       two of his Soldiers were gunned down have any bearing on your
       actions?
    5. In talking with this officer, he states that he worries his own
       inattention and distractibility may place his soldiers’ lives in jeopardy.
       He feels he is currently unfit to be leading Soldiers in battle. He also
       admits to frequent, intrusive thoughts regarding events that occurred
       during his first deployment? How do you respond?
    6. Following another consultation with mental health, the PVT is
       diagnosed as having a bipolar disorder. The provider explains that, in
       such a disorder, rapid and substantial mood swings are likely. The
       provider also explains that the PVT is not responding to medications
       for this disorder. What course of action do you think best in such a
       situation?

G-1, Human Resources Policy Directorate                                             3 September 2008   42
                                Scenario #6 – Deployed Captain
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

          OPERATIONAL QUESTIONS and ANSWERS:
    1. What would be the best response to the Captain’s statement, “I should have died with my
       men.”? (Ask further questions to clarify the Captain’s intent. Is he expressing a real wish to be
       dead? Is he merely expressing his grief and survivor’s guilt? Is there some other motivation for
       such a statement?)
    2. How soon should the Captain be returned to his leadership position? (As quickly as
       possible).
    3. Do you think this Captain is imminently suicidal? Why or why not? ( For discussion)
    4. Does the fact that this Captain failed to return fire on the enemy after two of his Soldiers
       were gunned down have any bearing on your actions? (While his “freezing up” may be a matter
       for discussion, we must distinguish that issue from the issue of suicide. We are interested in the
       Captain’s safety and his ability to return to duty. This Captain is having a normal human reaction to
       an abnormal situation. It is likely that he is experiencing posttraumatic stress disorder and
       “survivor’s guilt”, both of which could contribute to suicidal thoughts or intent.)
    5. In talking with this officer, he states that he worries his own inattention and distractibility
       may place his soldiers’ lives in jeopardy. He feels he is currently unfit to be leading
       Soldiers in battle. He also admits to frequent, intrusive thoughts regarding events that
       occurred during his first deployment? How do you respond? (You should encourage the
       Captain to speak with a chaplain or mental health care provider. Has this Captain “fallen off his
       horse”, and does he need to get back on and ride again? Is the Captain’s concern that he may fail
       his men sufficient that he needs to be medivac’d out of theater? Will continuing to serve only make
       his PTSD worse? Is his career over? These are issues for which the Captain requires
       consultation.)
    6. Following another consultation with mental health, the PVT is diagnosed as having a bipolar
       disorder. The provider explains that, in such a disorder, rapid and substantial mood swings
       are likely. The provider also explains that the PVT is not responding to medications for this
       disorder. What course of action do you think best in such a situation? (for the protection of
       the PVT and those around her, she should probably be “medivac’d” to Europe or CONUS for more
       intensive examination and treatment. If she does not respond to treatment, a medical board is
       probably necessary).

G-1, Human Resources Policy Directorate                                               3 September 2008   43
                            Scenario #7 – Deployed Female SSG
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired


    Prior to her deployment, this 30 year old, National Guard SSG had a violent
    verbal argument with her husband. After 3 months in theater, she finds that she
    is still haunted by her memory of this argument. There is no relief from her
    husband; each time she calls home, her husband begins to argue again. During
    her most recent phone call, her husband stated, “The kids really miss you. You
    are a bad mother for leaving your babies like this. You are useless as a
    mother.” The SSG already feels powerless about her situation, and her
    husband’s last comments really hurt her.
    She is talking to the Chaplain.
    The Chaplain does not know:
             1. She is feeling quite guilty about being separated from her two
                young children.
             2. On several occasions, her husband has threatened to divorce her.
             3. Since deploying, she has not slept or eaten well.
             4. She has thought several times of killing herself using her own
                weapon.
    At some point during the conversation, she states, “I am useless to my
    family…my children would be better off if I were dead.”




G-1, Human Resources Policy Directorate                                             3 September 2008   44
                            Scenario #7 – Deployed Female SSG
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                                STRATEGIC QUESTIONS:
    1. What is the role of Chaplains in cases of potential suicide?
    2. It is a community standard that the least restrictive environment be
       used when treating people. As a result, individuals are not
       psychiatrically hospitalized involuntarily unless they are at an
       imminent risk to themselves and others. How should we as an
       organization define imminent risk?
    3. At what point should a Chaplain or mental health provider reveal
       confidential information to others?
    4. The Ferres doctrine states, in effect, that military leaders cannot be
       sued for actions which result in damages to a Soldier. If there was no
       Ferres Doctrine, how would you change the way you handle suicidal
       Soldiers?
    5. To what lengths do you think Command should go to rehabilitate a
       formerly suicidal individual? At what point do you determine to “cut
       your losses” and get rid of the individual?




G-1, Human Resources Policy Directorate                                             3 September 2008   45
                            Scenario #7 – Deployed Female SSG
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

               STRATEGIC QUESTIONS and ANSWERS:
    1. What is the role of Chaplains in cases of potential suicide? (They can provide an alternative to
       mental health services, and there is less stigma about consulting with the Chaplain. Chaplains may
       be more adept at exploring a person’s values and beliefs. Some individuals may feel more
       comfortable talking with a Chaplain. Some individuals may feel that they have greater
       confidentiality when speaking with a Chaplain.)
    2. It is a community standard that the least restrictive environment be used when treating
       people. As a result, individuals are not psychiatrically hospitalized involuntarily unless they
       are at an imminent risk to themselves and others. How should we as an organization define
       imminent risk? (Most federal and state courts have defined imminent risk as the probability that a
       person will harm him/herself or others within 24 hours.)
    3. At what point should a Chaplain or mental health provider reveal confidential information to
       others? (Release of confidential information is permitted when another health care provider is
       assisting in the treatment of the individual. Confidentiality may also be broken when the individual
       is imminently suicidal. If imminently homicidal, the provider may notify the MP’s and any specifically
       named target. For instance, it would be proper to alert SFC Jones that the SSG states that he will
       kill him tonight. It is not permissible to break confidentiality if the SM states something to the effect
       of, “I am going to kill people at random tonight. Confidentiality may also be broken in cases where
       the information obtained would significantly affect the unit’s ability to perform its mission. Finally,
       confidentiality may be broken in cases where the provider is ordered by a court to provide specific
       information).
    4. The Ferres doctrine states, in effect, that military leaders cannot be sued for actions which
       result in damages to a Soldier. If there was no Ferres Doctrine, how would you change the
       way you handle suicidal Soldiers? (for discussion).
    5. To what lengths do you think Command should go to rehabilitate a formerly suicidal
       individual? At what point do you determine to “cut your losses” and get rid of the
       individual? (For discussion).



G-1, Human Resources Policy Directorate                                                  3 September 2008    46
                            Scenario #7 – Deployed Female SSG
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                                  TACTICAL QUESTIONS:
    1. Besides talking with this person, what other action should you, as a
       Chaplain, take?
    2. As a Chaplain and because you feel that the SSG is probably not able to
       fully perform her duties, you recommend that her Command consider a short
       period of rest and restoration. The Commander asks, “Why?” What
       information can you or should you release to the Commander?
    3. When confronted with a case of potential suicide, what rules do you, as a
       Commander, use to decide what your best course of action is, e.g. referral to
       a Chaplain or mental health provider, versus possible UCMJ action, versus
       chapter action?
    4. After referring this Soldier for a mental status examination, the examining
       provider recommends that the individual be placed on unit watch. As the unit
       Commander, you feel to do so would impair your ability to accomplish your
       mission, because the unit watch would tie up too many of your Soldiers.
       What do you do?
    5. Instead of referring this Soldier for a mental status examination, you
       “strongly recommend” that she seek mental health consultation. A week
       later you learn that your unit is moving elsewhere in the theater. You call the
       mental health provider to find out whether or not this SSG can move with
       you. How do you respond when the mental health provider informs you that
       all contacts with the SSG were privileged and that, as a consequence,
       he/she cannot legally or ethically discuss the issue with you.

G-1, Human Resources Policy Directorate                                             3 September 2008   47
                            Scenario #7 – Deployed Female SSG
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                 TACTICAL QUESTIONS and ANSWERS:
    1. Besides talking with this person, what other action should you, as a Chaplain, take?
       (Confiscate the SSG’s weapon, explaining that you are doing this because you genuinely care
       about her).
    2. As a Chaplain and because you feel that the SSG is probably not able to fully perform her
       duties, you recommend that her Command consider a short period of rest and restoration.
       The Commander asks, “Why?” What information can you or should you release to the
       Commander? (Hopefully you would have already obtained a release of information from the SSG
       so you can be frank with the Commander. However, since the SSG’s condition can negatively
       effect unit performance you may discuss any information available to you about the SSG. You
       should release only that information which is pertinent to unit functioning).
    3. When confronted with a case of potential suicide, what rules do you, as a Commander, use
       to decide what your best course of action is, e.g. referral to a Chaplain or mental health
       provider, versus possible UCMJ action, versus chapter action? (for discussion).
    4. After referring this Soldier for a mental status examination, the examining provider
       recommends that the individual be placed on unit watch. As the unit Commander, you feel
       to do so would impair your ability to accomplish your mission, because the unit watch
       would tie up too many of your Soldiers. What do you do? (There are no right or wrong
       answers. For discussion.)
    5. Instead of referring this Soldier for a mental status examination, you “strongly recommend”
       that she seek mental health consultation. A week later you learn that your unit is moving
       elsewhere in the theater. You call the mental health provider to find out whether or not this
       SSG can move with you. How do you respond when the mental health provider informs you
       that all contacts with the SSG were privileged and that, as a consequence, he/she cannot
       legally or ethically discuss the issue with you. (This is a tough issue. How does one balance
       confidentiality with a Commander’s need to know? Breaking confidentiality can create a distrust of
       mental health providers among Soldiers. Failing to break confidentiality could impact the unit’s
       performance. In an ideal world, the SSG would grant the provider provide to the provider a
       justification for the release of the information, such as evidence that such information is essential to
       mission accomplishment.)
G-1, Human Resources Policy Directorate                                                  3 September 2008   48
                            Scenario #7 – Deployed Female SSG
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                             OPERATIONAL QUESTIONS:
    1. What is the best way to deal with a suicidal Soldier who is not an
       imminent risk, that is a Soldier who is unlikely to harm him/herself or
       others within the next 24 hours?
    2. How does one respond to this Soldier’s statement that: “I am useless
       to my family…my children would be better off if I were dead”.
    3. You are attempting to demonstrate that you truly care about the
       SSG. You say, “I know its tough right now, but this crisis is going to
       pass, and you will eventually feel better. Let’s talk some more about
       this tomorrow”. Is there anything wrong with this approach?
    4. When asked, this SSG cannot promise you that she will not harm
       herself before morning, when she is to consult with a mental health
       provider. What should you do?
    5. Why is it important to ask a potentially suicidal person about their
       plan to harm themselves?




G-1, Human Resources Policy Directorate                                             3 September 2008   49
                            Scenario #7 – Deployed Female SSG
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

          OPERATIONAL QUESTIONS and ANSWERS:
    1. What is the best way to deal with a suicidal Soldier who is not an imminent risk, that is a
       Soldier who is unlikely to harm him/herself or others within the next 24 hours? (Provide the
       Soldier with genuine care and support. Refer the Soldier to a mental health provider. Ensure that
       the Soldier cannot impulsively hurt him/herself by removing access to lethal means and
       maintaining the Soldier on unit watch until the crisis is over or until a mental health provider clears
       the Soldier to return to full duty status.)
    2. How does one respond to this Soldier’s statement that: “I am useless to my family…my
       children would be better off if I were dead”. (Ask direct questions such as, “Do you mean that
       you are considering suicide as an option?” or “How long have you been thinking of suicide?”)
    3. You are attempting to demonstrate that you truly care about the SSG. You say, “I know its
       tough right now, but this crisis is going to pass, and you will eventually feel better. Let’s talk
       some more about this tomorrow”. Is there anything wrong with this approach? (First of all,
       the SSG may get the feeling that you really do not understand her plight. She may feel that you are
       impatient or uncaring and do not have more time to spend with her. She may feel as if her
       problems are being dismissed as being unimportant. Many people commit suicide because they
       see no other way to solve their problems. There is nothing to prevent the SSG from hurting herself
       once you finish talking. “Tomorrow” holds no meaning to someone who is intent upon killing
       themselves. Any reassurance should take the form of, “I know some people who can help you with
       your problems, and I’m going to see that you get a chance to speak with them as soon as
       possible.”)
    4. When asked, this SSG cannot promise you that she will not harm herself before morning,
       when she is to consult with a mental health provider. What should you do? (Escort the
       Soldier to a mental health provider or a treatment facility with an emergency room).
    5. Why is it important to ask a potentially suicidal person about their plan to harm
       themselves? (You need to know something about the plan so you can remove any potentially
       lethal items from the environment. For instance, if a Soldier states he plans to shoot himself, his
       weapon should be confiscated.)


G-1, Human Resources Policy Directorate                                                  3 September 2008    50
                                 Scenario #8 - Post-Deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired


    A 23 year old, active duty SPC is in a rehabilitation hospital after losing a leg to
    an IED in Iraq. He also sustained a mild concussion from the blast. His
    recovery has been complicated by an infection. Prior to losing his leg, he was a
    marathon runner who loved to run.
    You are visiting this injured Soldier in the hospital.
    You do not know:
           1. He is feeling very hopeless about his future.
           2. He told his girlfriend to stop visiting him.
           3. He is feeling that he is a burden to his family.
           4. He attempted suicide by a drug overdose two weeks ago
           5. He has been stockpiling his pain medications.
           6. He is undecided about killing himself.
    During your conversation with this Soldier, he states, “I can’t live this way.”




G-1, Human Resources Policy Directorate                                             3 September 2008   51
                                 Scenario #8 - Post-Deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                                STRATEGIC QUESTIONS:
    1. With the current shortage of medical personnel, is it probably
       inevitable that medical staff will focus on the physical injuries, leaving
       the invisible psychological injuries untreated. How would you modify
       your policies and procedures to ensure that Soldiers like this one
       receive the psychological care they deserve?
    2. As a health care provider, you are concerned that returning injured
       Soldiers seem to be withdrawing socially and distancing themselves
       from friends and loved ones. Would you make any changes in your
       treatment plans? If so, what kinds of changes?
    3. How can one reduce the boredom and sense of
       hopelessness/helplessness experienced by Soldiers in Warrior
       Transition Units?
    4. What is the best way to deal with individuals in WTU’s who appear to
       be “padding their nest”, i.e. presenting greater disability than can be
       accounted for on the basis of their injuries?
    5. How can line officers and health care providers better cooperate to
       reduce suicides?



G-1, Human Resources Policy Directorate                                             3 September 2008   52
                                 Scenario #8 - Post-Deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

               STRATEGIC QUESTIONS and ANSWERS:
    1. With the current shortage of medical personnel, is it probably inevitable that medical staff
       will focus on the physical injuries, leaving the invisible psychological injuries untreated.
       How would you modify your policies and procedures to ensure that Soldiers like this one
       receive the psychological care they deserve? (Make a routine psychological assessment part of
       the initial admission physical and schedule routine psychological follow-up sessions during the
       course of treatment. Do not have staff wait until a psychological crisis arises before obtaining
       mental health services. Educate staff regarding dual- and multiple diagnosis cases and the needs
       of such cases for early mental health intervention.)
    2. As a health care provider, you are concerned that returning injured Soldiers seem to be
       withdrawing socially and distancing themselves from friends and loved ones. Would you
       make any changes in your treatment plans? If so, what kinds of changes? (for discussion).
    3. How can one reduce the boredom and sense of hopelessness/helplessness experienced by
       Soldiers in Warrior Transition Units? (Find meaningful work and activities for the Soldier’s when
       they are not being treated.)
    4. What is the best way to deal with individuals in WTU’s who appear to be “padding their
       nest”, i.e. presenting greater disability than can be accounted for on the basis of their
       injuries? (First, understand that, if an error in judgment is to be made, it is better to err on the side
       of the Soldier. Secondly, it is often very difficult to differentiate between malingering and factitious
       disorders [disorders wherein medical complains appear to be expressed for the sole purpose of
       gaining the attention of health care providers]. Also understand that many Soldiers feel, perhaps
       justifiably, that they will be “short-changed” by the Medical Evaluation Board. Thus, in order to
       receive “justice”, they must present with an overabundance of symptoms so that, in the end, they
       will be properly reimbursed. If malingering can be firmly established, the Soldier should be
       confronted and made aware of the consequences of such behavior. However, it will frequently take
       some sort of “face-saving” maneuver to permit such individuals to gracefully give up their excess
       symptoms).
    5. How can line officers and health care providers better cooperate to reduce suicides? (for
       discussion).

G-1, Human Resources Policy Directorate                                                   3 September 2008   53
                                 Scenario #8 - Post-Deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                                  TACTICAL QUESTIONS:
1. As this unit’s commander, you are surprised to find yourself thinking about
   suicide. Your mission has been brutal on you and your Soldiers. You have
   lost a number of Soldiers. The demands on you are incredible, and you
   cannot seem to obtain adequate rest. You find yourself easily distracted.
   You have lost about 20 pounds over the past 3 months. You have concerns
   that your wife is not being faithful, and you miss your children. On top of all
   this, your First Sergeant informs you that the SPC is probably suicidal and
   almost certainly depressed. What is your course of action?
2. How do you, as the unit Commander, “keep your hand on the pulse” of
   your unit’s psychological health?
3. How does one, as in this case, sever ties with a unit member who is going
   to be medically boarded in such a way as to maintain unit morale while
   also contributing to the psychological health of the separated soldier? Is
   this even possible? Is it even desirable?
4. The Soldier appears to be withdrawing socially. He has asked his girlfriend
   not to visit, and he has requested that staff not permit you to visit him. How
   should you respond?
5. Do you gauge the capability, as the unit commander, to influence the
   course of this SPC’s treatment and recovery? How?

G-1, Human Resources Policy Directorate                                             3 September 2008   54
                                   Scenario #8 - Post-Deployment
           Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                   TACTICAL QUESTIONS and ANSWERS:
1. As this unit’s commander, you are surprised to find yourself thinking about suicide. Your mission has been
   brutal on you and your Soldiers. You have lost a number of Soldiers. The demands on you are incredible,
   and you cannot seem to obtain adequate rest. You find yourself easily distracted. You have lost about 20
   pounds over the past 3 months. You have concerns that your wife is not being faithful, and you miss your
   children. On top of all this, your First Sergeant informs you that the SPC is probably suicidal and almost
   certainly depressed. What is your course of action? (Let your first sergeant handle the suicidal specialist.
   He/she is more than capable. You must also take care of yourself. Consultation with a mental health provider is
   likely to prove useful. If you are reluctant to seek assistance, what will your Soldiers feel about seeking assistance?
   If you are worried that your Soldiers will learn of your consultation, don’t worry. You are setting a healthy example
   for them, and you are helping demystify and de-stigmatize mental health services. Overall, you and your unit will be
   better off if you take the time to take care of yourself.)
2. How do you, as the unit Commander, “keep your hand on the pulse” of your unit’s psychological health?
   (Socrates was a wise man indeed. First, know yourself. Do you feel uncomfortable talking about mental health
   issues either because you feel untrained or because you find such discussions meaningless or because such
   discussions raise your own level of anxiety? You must know your Soldiers. You must have an NCO staff that freely
   communicates both up and down the chain-of-command. You must provide an atmosphere in which Soldiers feel
   free to discuss any of their problems without fear of retribution, embarrassment, or punishment. You must give as
   much attention to the mental health of Soldiers as you do to their physical health. Your Soldiers must feel they can
   trust you to protect them physically AND psychologically.)
3. How does one, as in this case, sever ties with a unit member who is going to be medically boarded in such
   a way as to maintain unit morale while also contributing to the psychological health of the separated
   soldier? Is this even possible? Is it even desirable? (No right or wrong answers. For discussion).
4. The Soldier appears to be withdrawing socially. He has asked his girlfriend not to visit, and he has
   requested that staff not permit you to visit him. How should you respond? (Discuss this concern with the
   treating mental health specialist and /or his treating physician or the treatment team. They may need you and the
   Soldier’s girlfriend to continue visiting the patient, in spite of the Soldier’s requests, as part of his rehabilitation. This
   Soldier has experienced some significant losses, and he is angry. Unfortunately he is inappropriately expressing his
   anger toward you and his girlfriend. Do not take offense. This soldier’s treatment team, if they practice according to
   community standards, has already performed a thorough evaluation, including a psychological evaluation, on the
   Soldier. Since you are unaware that the Soldier is stockpiling his medications, you can do nothing more than
   express concern, for the soldier, to the treatment team.
5. Do you gauge the capability, as the unit commander, to influence the course of this SPC’s treatment and
   recovery? How? (For discussion).
G-1, Human Resources Policy Directorate                                                            3 September 2008     55
                                 Scenario #8 - Post-Deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                             OPERATIONAL QUESTIONS:
1. How do you respond when the Soldier states, “I can’t live this way”?
2. If the Soldier responds that he has thought about committing suicide, how
   would you determine the degree of risk involved?
3. After talking to this Soldier, you feel he is not at an imminent risk to harm
   himself. What should you do next?
4. Learning that you have “told on him”, the Soldier becomes very angry with
   you, demanding that you leave him alone and calling you names. How
   should you respond?
5. The Soldier reveals, during the course of your conversation, that he has
   been stockpiling his medications “…just in case”. What should your
   response be?




G-1, Human Resources Policy Directorate                                             3 September 2008   56
                                 Scenario #8 - Post-Deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

          OPERATIONAL QUESTIONS and ANSWERS:
1. How do you respond when the Soldier states, “I can’t live this way”? (Help him clarify his
   thoughts by asking questions, such as “What do you mean by that?”, “Are you considering hurting
   yourself?”, “Have you spoken to anyone about these feelings?”)
2. If the Soldier responds that he has thought about committing suicide, how would you
   determine the degree of risk involved? (Determine if the Soldier is at imminent risk by asking him
   if he has plans to harm himself and if he really intends to carry out these plans. Ask about
   commonly known risk factors such as previous suicide attempts, depression, social withdrawal, etc.)
3. After talking to this Soldier, you feel he is not at an imminent risk to harm himself. What
   should you do next? (Understand that you are not qualified, by virtue of training or experience, to
   make a judgment regarding the degree of risk. Convey your sincere concern and care for him. Try to
   get the Soldier to speak with a Chaplain or mental health provider about his feelings. If the Soldier
   refuses or gives you a lukewarm response, you should report the Soldier’s suicidal thoughts to his
   treatment team, his commander, a mental health provider, or a Chaplain. Remember, since you do
   not have a therapeutic relationship with this Soldier, you are not bound by rules related to
   confidentiality. In fact, the Soldier may be secretly hoping that you will report his suicidality, feeling
   unable to do so himself).
4. Learning that you have “told on him”, the Soldier becomes very angry with you, demanding
   that you leave him alone and calling you names. How should you respond? (Do not become
   angry in response. Understand that the Soldier is appropriately angry regarding his circumstances
   and that he is inappropriately directing that anger towards you. Reassure the Soldier that you care
   for him and that you are available if he needs you. You might consider revisiting him once he has
   had time to cool off.)
5. The Soldier reveals, during the course of your conversation, that he has been stockpiling his
   medications “…just in case”. What should your response be? (Express care for the Soldier by
   telling him you are either going to remove the stockpile of pills, or you are going to have the hospital
   staff remove them.)
G-1, Human Resources Policy Directorate                                             3 September 2008   57
                                          Scenario #9 - R&R
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired


    A 23 year old, active duty SPC has been deployed to Afghanistan for 8 months.
    He is going home on R & R and wants to surprise his family and girlfriend. In
    fact, he hopes to propose marriage to his girlfriend of four years. Upon arrival,
    he learns that his girlfriend is pregnant by another man. He is devastated.
    You are a friend of this SM.
    You do not know:
         1. This SM is very depressed.
         2. This SM is abusing alcohol.
         3. He feels as though there is nothing else to live for.
         4. He has purchased a weapon.
    During the conversation, this SM states, “While in Afghanistan, thinking about
    her helped me to cope. I can’t see myself living without her.”




G-1, Human Resources Policy Directorate                                             3 September 2008   58
                                          Scenario #9 - R&R
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                                STRATEGIC QUESTIONS:
1. As a Commander establishing a suicide prevention program, to what degree do you
   consider generational differences, such as “baby-boomers” versus “generation X”?
2. The Army seems to have provided significant resources to assist the spouse and
   children of deployed service members. However, there do not appear to be similar
   agencies/policies to support the significant others of unmarried Soldiers. Is this fair?
   What more can we, as an organization, do to help support these people?
3. The Army and her sister services recruit mostly from a pool of young, unskilled
   individuals. Such individuals, in general, also tend to be socially unskilled.
   Moreover, we are now recruiting more individuals with criminal backgrounds, pre-
   existing psychological problems, and lower intellectual skills. Are there ways we
   can accelerate the social maturity of such individuals, or do we have to wait for
   development to take it’s time? Does the Army currently have any mechanism for
   increasing the social skills and maturity of new Soldiers? If so, what are these
   mechanisms? What additional measures can the Army take to increase the
   resilience and social maturity of these individuals?
4. How does a Commander promote help-seeking behaviors within his/her
   organization?
5. How does a Commander monitor his/her unit for possible suicidal intent?




G-1, Human Resources Policy Directorate                                             3 September 2008   59
                                          Scenario #9 - R&R
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

              STRATEGIC QUESTIONS and ANSWERS:
1. As a Commander establishing a suicide prevention program, to what degree do you consider
   generational differences, such as “baby-boomers” versus “generation X”? (While it is true that certain
   age groups, most notable 25 and under and 65 and above have higher rates of suicide, the National
   Academy of Sciences, in response to a request for information from Army senior leadership, has noted that
   there is no scientific evidence for significant generational differences in behaviors and attitudes. Thus, the
   much heralded generational differences should not be a consideration when designing a suicide prevention
   program.)
2. The Army seems to have provided significant resources to assist the spouse and children of
   deployed service members. However, there do not appear to be similar agencies/policies to support
   the significant others of unmarried Soldiers. Is this fair? What more can we, as an organization, do
   to help support these people? (for discussion).
3. The Army and her sister services recruit mostly from a pool of young, unskilled individuals. Such
   individuals, in general, also tend to be socially unskilled. Moreover, we are now recruiting more
   individuals with criminal backgrounds, pre-existing psychological problems, and lower intellectual
   skills. Are there ways we can accelerate the social maturity of such individuals, or do we have to
   wait for development to take it’s time? Does the Army currently have any mechanism for increasing
   the social skills and maturity of new Soldiers? If so, what are these mechanisms? What additional
   measures can the Army take to increase the resilience and social maturity of these individuals? (for
   discussion).
4. How does a Commander promote help-seeking behaviors within his/her organization? (First and
   foremost, the Commander must him/her-self believe that help-seeking behaviors are healthy. This belief
   must then be accepted at all echelons. He/she must take all measures to reduce any stigma attached to
   help-seeking behavior. Taunting or teasing someone who has sought assistance must be eliminated.)
5. How does a Commander monitor his/her unit for possible suicidal intent? (First, know your Soldiers
   and their families so you can recognize or even anticipate behavioral problems. Promote the buddy system.
   Train your NCO’s to know and monitor their Soldiers. Create an atmosphere of inclusion and acceptance for
   all unit members Know the warning signs for suicide: loneliness, worthlessness, hopelessness, etc. Talk
   with your Soldiers following any major change in their life circumstances. )
G-1, Human Resources Policy Directorate                                                3 September 2008   60
                                          Scenario #9 - R&R
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                                  TACTICAL QUESTIONS:
1. Other Soldiers are the first line of defense in the Army’s suicide prevention
   program. How do you prepare yourself for this role? What behaviors must
   you master in order to fulfill this role?
2. How much training in suicide prevention is enough? How much can
   realistically fit into your training schedule? How frequently should such
   training be given? How should new arrivals to your unit be included in this
   process? When can one stop training in suicide prevention?
3. Is suicide a medical or Command problem. How can behavioral health
   specialists and unit Commanders best work together to reduce the
   occurrence of suicidal behaviors?
4. As a unit commander, do you think someone who has been psychiatrically
   hospitalized for suicidal behaviors can ever be successfully reintegrated
   into the unit?
5. What kind(s) of training do you think is necessary to “harden up” Soldiers,
   make them more resilient, and make them less vulnerable to suicidal
   impulses? Do you think BATTLEMIND is enough to reduce suicidal
   behaviors?

G-1, Human Resources Policy Directorate                                             3 September 2008   61
                                          Scenario #9 - R&R
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                 TACTICAL QUESTIONS and ANSWERS:
1. Other Soldiers are the first line of defense in the Army’s suicide prevention program.
   How do you prepare yourself for this role? What behaviors must you master in order to
   fulfill this role? (Know the warning signs of suicide. Know the leading causes of suicide, Be
   constantly vigilant. Take immediate action when you suspect that someone may be suicidal.
   Use ACE. Be aware of the resources available to assist the Soldier. Use the expertise of your
   chain-of-command. Help promote the view that help-seeking behaviors are healthy and a sign
   of courage, strength, and intelligence.)
2. How much training in suicide prevention is enough? How much can realistically fit into
   your training schedule? How frequently should such training be given? How should
   new arrivals to your unit be included in this process? When can one stop training in
   suicide prevention? (for discussion; training can never be stopped)
3. Is suicide a medical or Command problem. How can behavioral health specialists and
   unit Commanders best work together to reduce the occurrence of suicidal behaviors?
   (there may be disagreement, but suicide appears to be a Command problem in that
   Commanders have the means to create a supportive and caring environment. The behavioral
   health provider is best viewed as a consultant to the unit Commander, providing the
   Commander with information to help him/her make personnel management decisions)
4. As a unit commander, do you think someone who has been psychiatrically hospitalized
   for suicidal behaviors can ever be successfully reintegrated into the unit? (for
   discussion).
5. What kind(s) of training do you think is necessary to “harden up” Soldiers, make them
   more resilient, and make them less vulnerable to suicidal impulses? Do you think
   BATTLEMIND is enough to reduce suicidal behaviors? (again, for discussion).

G-1, Human Resources Policy Directorate                                             3 September 2008   62
                                          Scenario #9 - R&R
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                             OPERATIONAL QUESTIONS:
1. How would you employ the ACE strategy to help this service member?
2. What risk factors are present to suggest that this individual may act
   impulsively to harm himself?
3. Since you do not know about these risk factors, how are you going to make
   a judgment regarding this Soldier’s needs?
4. Once your friend conveys possible suicidal ideation to you, do you have a
   moral, ethical, or legal obligation to him?
5. How does one know when the acute danger of suicide has passed?




G-1, Human Resources Policy Directorate                                             3 September 2008   63
                                          Scenario #9 - R&R
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

          OPERATIONAL QUESTIONS and ANSWERS:
1. How would you employ the ACE strategy to help this service member? (Ask him about
   any possible suicidal feelings. Do not be satisfied with an initial, “No”. If he is indeed suicidal,
   care for him by removing any means of inflicting self harm and escort him to a mental health
   provider. If he is not suicidal, he may still need mental health services to assist him in dealing
   with his current depression and loss.)
2. What risk factors are present to suggest that this individual may act impulsively to
   harm himself? (He has the means, i.e. a weapon. He is depressed and probably not thinking
   clearly, and he is abusing alcohol. He feels hopeless and does not see alternatives available
   to him.)
3. Since you do not know about these risk factors, how are you going to make a judgment
   regarding this Soldier’s needs? (You are not going to make such a judgment; you will leave
   that to the professionals. Your job is to get your friend to those professionals. However, in
   determining your course of action, always be conservative, erring if necessary in the direction
   of safety. Given the information you DO have, it would be wise to escort your friend to a
   mental health provider’s, or a Chaplain’s, office for further evaluation. You already have
   indications of suicidal thought, given the Soldier’s statement to the effect, “…I can no longer
   cope; I can’t live without her.”)
4. Once your friend conveys possible suicidal ideation to you, do you have a moral,
   ethical, or legal obligation to him? (In this scenario, one certainly has an ethical obligation
   to his/her friend. Helping your friend is certainly the “right” thing to do. In terms of morality, any
   obligation you have would depend upon your own personal beliefs and attitudes. Any legal
   obligation would be defined by Army regulation and/or local policies and procedures.)
5. How does one know when the acute danger of suicide has passed? (The mental health
   professional, Chaplain, or chain-of-command will let you know.)
G-1, Human Resources Policy Directorate                                             3 September 2008   64
                                 Scenario #10 – Pre-deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired


    You are the friend of a 34 year old Reserve Captain who has been passed over
    for a promotion. Your friend was unexpectedly called-up to deploy. He cannot
    afford to deploy because of his huge mortgage payment. If deployed, your
    friend would need to sell his house, because his Army pay would be
    inadequate to cover the mortgage. His spouse thinks he volunteered for
    deployment and threatens to leave him if he sells the house.
    You are talking with your friend.
    You do not know:
               1. He is feeling very hopeless about his situation.
               2. He has recently increased his life insurance.
               3. He has frequent thoughts about dying in combat so his family can
                  collect the life insurance.
    At some point in the conversation, your friend says, “If I die, my life insurance
    will pay off the mortgage on my house. My family will always have a place to
    live.”




G-1, Human Resources Policy Directorate                                             3 September 2008   65
                                 Scenario #10 – Pre-deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                                STRATEGIC QUESTIONS:
1. As an organization, how can we better support our reservists and
   guardsmen who are called to active duty?
2. In cases such as this, can we make necessary services available to
   reservists and guardsmen BEFORE and AFTER they enter active duty?
   Why or why not?
3. In what ways can we better support the families of reservists and
   guardsmen on active duty?
4. When should reservists and guardsmen receive training in suicide
   prevention?
5. Do you think reservists and guardsmen experience unique stressors that
   could place them at increased risk of suicide? Why or why not?




G-1, Human Resources Policy Directorate                                             3 September 2008   66
                                 Scenario #10 – Pre-deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

              STRATEGIC QUESTIONS and ANSWERS:
1. As an organization, how can we better support our reservists and guardsmen
   who are called to active duty? (for discussion)
2. In cases such as this, can we make necessary services available to reservists
   and guardsmen BEFORE and AFTER they enter active duty? Why or why
   not? (for discussion)
3. In what ways can we better support the families of reservists and guardsmen
   on active duty? (for discussion).
4. When should reservists and guardsmen receive training in suicide
   prevention? (Before, during, and after each deployment.)
5. Do you think reservists and guardsmen experience unique stressors that
   could place them at increased risk of suicide? Why or why not? (for discussion




G-1, Human Resources Policy Directorate                                             3 September 2008   67
                                 Scenario #10 – Pre-deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                                  TACTICAL QUESTIONS:
1. As reservists and guardspersons are assigned to your unit, what kinds of things can
   you do to decrease their risk of suicide?
2. You have learned that this Captain is feeling hopeless and has entertained some
   thoughts of suicide. You decide to counsel him. What kinds of things would you, as
   his Commander, say? What kind of referrals might you make? Are there other
   resources available to help this officer solve his problems in a more appropriate
   manner?
3. In talking with this young officer, he states that he feels overwhelmed and that he
   fears his decision-making might be impaired. He does not know how to get back on
   track and, though he is not currently suicidal. He keeps having recurrent, intrusive
   thoughts about what it might be like to be dead. He has begun to question the
   meaning of life. He states he cannot guarantee that he will not, at some point in the
   future, engage in suicidal behaviors. What do you do?
4. The Captain takes your advice and seeks mental health consultation. He is placed
   on antidepressant medications. However, six weeks later, he feels no better and
   continues to experience his symptoms. What should you do next?
5. The mental health provider ultimately decides that hospitalization is in the Captain’s
   bests interest. Realistically, do you feel this Captain can return from his
   hospitalization and successfully be reintegrated into his leadership position?



G-1, Human Resources Policy Directorate                                             3 September 2008   68
                                 Scenario #10 – Pre-deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                TACTICAL QUESTIONS and ANSWERS:
1. As reservists and guardspersons are assigned to your unit, what kinds of things can you do to
   decrease their risk of suicide? (Get to know them, their needs, their expectations, and their
   fears/anxieties. Ensure that they have received training in BATTLEMIND and suicide prevention. Social
   gatherings might also be used to assist the newly assigned Soldiers in feeling accepted as part of the team.
   Help them feel assured that you will be looking out for their interests and that problems can be voiced
   without fear of retribution or ridicule.)
2. You have learned that this Captain is feeling hopeless and has entertained some thoughts of
   suicide. You decide to counsel him. What kinds of things would you, as his Commander, say? What
   kind of referrals might you make? Are there other resources available to help this officer solve his
   problems in a more appropriate manner? (for discussion).
3. In talking with this young officer, he states that he feels overwhelmed and that he fears his decision-
   making might be impaired. He does not know how to get back on track and, though he is not
   currently suicidal. He keeps having recurrent, intrusive thoughts about what it might be like to be
   dead. He has begun to question the meaning of life. He states he cannot guarantee that he will not,
   at some point in the future, engage in suicidal behaviors. What do you do? (Refer this officer to mental
   health providers. Assure the Captain that there will be no negative consequences for seeking mental health
   consultation.)
4. The Captain takes your advice and seeks mental health consultation. He is placed on antidepressant
   medications. However, six weeks later, he feels no better and continues to experience his
   symptoms. What should you do next? (Your should obtain, from the Captain, authority to discuss his
   problems with his mental health provider. Next, consult with the provider to determine the best course of
   action. Hospitalization might be required.)
5. The mental health provider ultimately decides that hospitalization is in the Captain’s bests interest.
   Realistically, do you feel this Captain can return from his hospitalization and successfully be
   reintegrated into his leadership position? (for discussion)



G-1, Human Resources Policy Directorate                                              3 September 2008   69
                                 Scenario #10 – Pre-deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                             OPERATIONAL QUESTIONS:
1. In response to your friend’s statement that his life insurance will pay off the
   mortgage in the event of his death, how should you respond to your friend?
2. Your friend, in response to your questioning replies, “Oh…I’m not thinking
   of suicide. I could never do that. I love my family too much.” How might
   you respond?
3. In response to your statements, the friend says, “You know, I never thought
   of that. You might be right!” What might you say now?
4. Why did you not escort your friend immediately to a mental health
   provider?
5. Your friend elects not to seek assistance, and his condition continues to
   decay. He has taken to drinking heavily, and he seems to cry at the drop of
   a hat. He speaks to you very infrequently. His wife states he has purchased
   a handgun. He eats only rarely and has lost about 20 pounds. What
   should you do?




G-1, Human Resources Policy Directorate                                             3 September 2008   70
                                 Scenario #10 – Pre-deployment
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

         OPERATIONAL QUESTIONS and ANSWERS:
1. In response to your friend’s statement that his life insurance will pay off the mortgage in the event of his
   death, how should you respond to your friend? (His statement is ambiguous in terms of intent to harm himself.
   It is obvious that he is experiencing intense distress. The next step would be to clarify your friend’s statements by
   asking such questions as, “…are you going to intentionally put yourself in danger? Are you thinking about suicide?;
   Are you intending to die?”
2. Your friend, in response to your questioning replies, “Oh…I’m not thinking of suicide. I could never do
   that. I love my family too much.” How might you respond? (A good response would be, “Well, I’m glad to hear
   that. However, I wonder if all this stress may preoccupy you to the point that you might be distracted while in
   theater. That could put you at greater risk of being injured or killed.”.)
3. In response to your statements, the friend says, “You know, I never thought of that. You might be right!”
   What might you say now? (Well then, you might take some time now, before you deploy, to try to resolve some of
   your problems. You could speak to a JAG officer regarding your legal rights while deployed. You and your wife
   could also get some assistance with your marital difficulties, though it sounds like the marriage will be much better
   once she no longer has to fear losing the house.)
4. Why did you not escort your friend immediately to a mental health provider? (While your friend is
   experiencing a tremendous amount of stress, he has not said anything to indicate that he is in imminent danger to
   himself or others. Through your questioning, you have determined that your friend wants to live; he is just
   experiencing some vague thoughts about dying in order to save his family. You have directed him to sources of
   assistance, and he appears motivated to resolve his problems. )
5. Your friend elects not to seek assistance, and his condition continues to decay. He has taken to drinking
   heavily, and he seems to cry at the drop of a hat. He speaks to you very infrequently. His wife states he has
   purchased a handgun. He eats only rarely and has lost about 20 pounds. What should you do? (In this
   case, where you suspect that your friend is suicidal but not imminently suicidal, you might consult with a mental
   health professional regarding your best course of action. You could also speak to your friend again to reassess his
   potential for self harm. You could speak with his wife regarding your concerns. However, she may be as confused
   as you are. Perhaps she can locate the handgun and remove it (caring) from the house while your friend is so
   depressed. You could also insist that your friend accompany you (escort) to a mental health provider or an
   emergency room. The key issue here is that your friend is technically a civilian and cannot have his civil rights taken
   from him unless he is IMMINENTLY dangerous to himself or others.)


G-1, Human Resources Policy Directorate                                                      3 September 2008     71
                           Scenario #11 – Basic Training Brigade
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired


    You are the sergeant major of a basic training battalion. You notice that your
    Commander, an infantry LTC in his late 40’s, has become increasingly irritable.
    His appearance has also begun to deteriorate, and he frequently arrives to
    work unshaven and in a dirty uniform. He complains that this assignment has
    gotten ”TRADOC Slime” on him and that he will never again be able to get a
    good assignment. During your conversations with him, you notice that he is
    easily distracted and his mind seems to be elsewhere. He is having trouble
    remembering his schedule. He has stopped his morning runs and has gained
    about 20 pounds over the past few months. During one conversation, he
    described to you an incident which occurred while he worked in the US
    embassy in Egypt. He states that Bulgarian agents kidnapped him and held him
    for ransom. He states the incident was not publicized because of possible
    political ramifications. The LTC has also been “called on the carpet” recently
    because there was a trainee suicide within his battalion. He stated, “My career
    is over.” He occasionally falls asleep in his office. On one occasion, you
    inadvertently discovered him crying in his office.
    What you do not know:
           1. The LTC is having marital problems.
           2. His eldest son just flunked out of college.
           3. The LTC has been experiencing frequent, intrusive thought of suicide.
           4. The LTC’s sleep has been highly fragmented.
           5. The LTC has recently been passed over for promotion.
    At some point in the conversation, the LTC states, “I don’t know if it’s worth it to
    continue.”
G-1, Human Resources Policy Directorate                                             3 September 2008   72
                           Scenario #11 – Basic Training Brigade
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                                STRATEGIC QUESTIONS:
1.      While suicide rates seem to be escalating among younger soldiers,
        there seems to be less attention, in terms of suicide prevention, to the
        psychological health of more senior leadership. Do you agree or
        disagree with this contention. If you agree, what recommendations can
        you make?
2.      Is the stigma regarding mental health services disproportionately high
        among our more senior leadership? Why or why not?
3.      Do you think routine mental health evaluations should be required for all
        personnel just as routine physical examinations are required? Why or
        why not?
4.      Do you think that such periodic “psychological examination” could help
        reduce the stigma regarding mental health services? Why or why not?
        (for discussion)
5.      Do you think that some people are, by nature, more vulnerable to the
        effects of distressing events? Should we, as an organization, “weed
        out”, or at least identify, the weaker people? Why or why not?

G-1, Human Resources Policy Directorate                                             3 September 2008   73
                           Scenario #11 – Basic Training Brigade
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

             STRATEGIC QUESTIONS and ANSWERS:
1.      While suicide rates seem to be escalating among younger soldiers, there seems to
        be less attention, in terms of suicide prevention, to the psychological health of
        more senior leadership. Do you agree or disagree with this contention. If you agree,
        what recommendations can you make? (Suicide rates are highest among the youngest
        and oldest Soldiers. Discuss what to do for more senior Soldiers to prevent suicide.)
2.      Is the stigma regarding mental health services disproportionately high among our
        more senior leadership? Why or why not? (for discussion).
3.      Do you think routine mental health evaluations should be required for all personnel
        just as routine physical examinations are required? Why or why not? (for
        discussion).
4.      Do you think that such periodic “psychological examination” could help reduce the
        stigma regarding mental health services? Why or why not? (for discussion)
5.      Do you think that some people are, by nature, more vulnerable to the effects of
        distressing events? Should we, as an organization, “weed out”, or at least identify,
        the weaker people? Why or why not? (people differ on any number of dimensions such
        as height, weight, hair color, etc.; they also differ in terms of their ability to tolerate
        distress; some individuals are more sensitive, reactive, and impulsive than others;
        additionally, some behavioral disorders like depression may have a genetic basis, with
        some individuals being more prone to develop behavioral problems. Even though an
        individual might possess some”weaknesses” as all people do, their strengths should also
        be considered. What if we “weeded out all people with red hair?).

G-1, Human Resources Policy Directorate                                             3 September 2008   74
                           Scenario #11 – Basic Training Brigade
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                                  TACTICAL QUESTIONS:
1. How do you, as the brigade Commander, promote compassionate suicide prevention
   attitudes while at the same time fostering discipline and trying to reduce trainee attrition?
   Are these mutually exclusive goals? Does one goal interfere with the attainment of other
   goals? Explain.
2. As the brigade Commander, how do you respond when representatives from the Army
   medical center approach you requesting two hours to test all trainees as part of a
   research project designed to reduce suicide rates?
3. With the Army accepting increasing numbers of trainees with criminal histories, lower
   aptitude scores, and more moral waivers, how do you modify your suicide prevention
   program, if indeed it is necessary to modify it at all, to keep suicides to a minimum
   among your trainees?
4. You have noticed that a fairly sizable percentage of trainees report to the Community
   Mental Health Service seeking discharge because they are “suicidal”. This percentage
   has increased since one trainee was indeed discharged for a personality disorder after
   complaining of suicidal thoughts. You assume, probably rightly so, that the increase is
   due to a “copy-cat” effect, and the local MEDDAC Commander is complaining that his
   mental health resources are being stretched to the point of breaking. How do you
   respond to this situation without increasing the stigma attached to the seeking of mental
   health services, without discouraging individuals with bona fide problems from seeking
   services, without increasing the burden upon the Community Mental Health Service, and
   without compromising your training standards?
5. How do you train your staff to be compassionate and to respond to requests for mental
   health consultation without ridicule or retribution while still maintaining discipline and
   training standards? Is this even a problem?
G-1, Human Resources Policy Directorate                                             3 September 2008   75
                           Scenario #11 – Basic Training Brigade
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

               TACTICAL QUESTIONS and ANSWERS:
1. How do you, as the brigade Commander, promote compassionate suicide prevention attitudes while
   at the same time fostering discipline and trying to reduce trainee attrition? Are these mutually
   exclusive goals? Does one goal interfere with the attainment of other goals? Explain. (for discussion)
2. As the brigade Commander, how do you respond when representatives from the Army medical
   center approach you requesting two hours to test all trainees as part of a research project designed
   to reduce suicide rates? (One would hope that you would be as cooperative as is reasonably possible. It
   is understood that we, as an organization, make numerous demands on training time and that yet another
   such demand would create scheduling and logistic problems. Yet, the psychological health and cognitive
   abilities are extremely important, especially on the postmodern battlefield. Advances in Soldier
   psychological abilities will not occur without additional research. As a Commander, you must balance
   current time demands for training against future organizational improvement.)
3. With the Army accepting increasing numbers of trainees with criminal histories, lower aptitude
   scores, and more moral waivers, how do you modify your suicide prevention program, if indeed it is
   necessary to modify it at all, to keep suicides to a minimum among your trainees? (for discussion)
4. You have noticed that a fairly sizable percentage of trainees report to the Community Mental Health
   Service seeking discharge because they are “suicidal”. This percentage has increased since one
   trainee was indeed discharged for a personality disorder after complaining of suicidal thoughts. You
   assume, probably rightly so, that the increase is due to a “copy-cat” effect, and the local MEDDAC
   Commander is complaining that his mental health resources are being stretched to the point of
   breaking. How do you respond to this situation without increasing the stigma attached to the
   seeking of mental health services, without discouraging individuals with bona fide problems from
   seeking services, without increasing the burden upon the Community Mental Health Service, and
   without compromising your training standards? (for discussion; however it should be noted that first line
   personnel and Commanders are not qualified, by virtue of training or experience, to determine whether or
   not any individual trainee is truly suicidal or just malingering.)
5. How do you train your staff to be compassionate and to respond to requests for mental health
   consultation without ridicule or retribution while still maintaining discipline and training standards?
   Is this even a problem? (for discussion)
G-1, Human Resources Policy Directorate                                             3 September 2008   76
                           Scenario #11 – Basic Training Brigade
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                             OPERATIONAL QUESTIONS:
1. As LTC’s Commander, you also note changes in his demeanor and mood?
   What should you do?
2. Even after consulting with his boss, the LTC seems to continue to
   deteriorate. As his sergeant major, what would your best course of action
   be?
3. In your attempt to talk to the LTC, he remarks, “Don’t give me that suicide
   sissy prevention crap. If I’m going to commit suicide, no one will know
   beforehand. The only reason you’re here is because I do your EER.
   Besides, my problems are none of your business.” How do you respond
   now?
4. The LTC comes in one morning and says, “Thanks a lot for tattle-telling on
   me! Now I’ve been ordered to report to the Community Mental Health
   Service for a mental status examination! Do you have any idea how
   humiliating that is? Do you have any idea what this is going to do to my
   career? Why couldn’t you just mind your own business?” How do you
   respond?
5. The next morning you learn that the LTC had gone to one of the ranges
   and died from a self-inflicted gunshot would to his head. How do you
   respond?

G-1, Human Resources Policy Directorate                                             3 September 2008   77
                           Scenario #11 – Basic Training Brigade
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

         OPERATIONAL QUESTIONS and ANSWERS:
1. As LTC’s Commander, you also note changes in his demeanor and mood? What should you do? (Sit down
   with the LTC and have a frank, nonjudgmental conversation about your observations. Express genuine concern for
   him. Ask him directly if he has been depressed or if he has had thought of suicide and respond appropriately.)
2. Even after consulting with his boss, the LTC seems to continue to deteriorate. As his sergeant major, what
   would your best course of action be? (Bring your concerns to his attention, and try to get him to consult with a
   mental health professional. If he does not respond appropriately, you should probably bring this to the brigade
   sergeant major.)
3. In your attempt to talk to the LTC, he remarks, “Don’t give me that suicide sissy prevention crap. If I’m
   going to commit suicide, no one will know beforehand. The only reason you’re here is because I do your
   EER. Besides, my problems are none of your business.” How do you respond now? (Obviously, you try to
   convince the LTC of your genuine concern. At this point, you might consider speaking with the brigade
   commander.)
4. The LTC comes in one morning and says, “Thanks a lot for tattle-telling on me! Now I’ve been ordered to
   report to the Community Mental Health Service for a mental status examination! Do you have any idea how
   humiliating that is? Do you have any idea what this is going to do to my career? Why couldn’t you just
   mind your own business?” How do you respond? (You might want to apologize, stating you were motivated
   only by your genuine concern regarding his current emotional state. You might also point out that you respect him
   as a Soldier and that you enjoy working under him. You might also say, “I’d hope you’d do the same thing for me if I
   were having difficulties.” Essentially, you want to normalize the situation as much as possible and to make sure the
   LTC knows that you are available if he ever wants to talk.)
5. The next morning you learn that the LTC had gone to one of the ranges and died from a self-inflicted
   gunshot would to his head. How do you respond? (Contact the family to see if there is anything you can do for
   them. Assess the emotional impact this event has had on you. Do you feel in any way responsible for what
   happened? You might want to seek a mental health provider to assist you in processing this event. You also want
   to assess the effect this event has had on your Soldier’s and NCO’s. It might be worth your while to consult with a
   mental health provider regarding the best way to help your Soldiers and NCO’s deal with the Commander’s death.
   Conduct an after action investigation with the other parties to see if there were things that could have been done
   differently to prevent this tragedy.)



G-1, Human Resources Policy Directorate                                                    3 September 2008    78
                                  Scenario #12 – Deployed PFC
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired


    PFC Jones has been the subject of considerable verbal abuse and bullying by
    SPC Smith. On several occasional, PFC Jones has come to you, as her battle
    buddy, crying and complaining of the treatment she is receiving at the hands of
    SPC Smith. On more than one occasion, you have spoken with SPC Smith and
    asked her to stop bullying PFC Jones. This morning, SPC Smith told Jones that
    she would “…come for her tonight and teach her a lesson.” Hearing this, you
    tell your platoon sergeant what is happening. She promises to speak with SPC
    Smith and, indeed, she orders SPC Smith to stay away from, and stop bullying,
    PFC Jones. That night, SPC Smith went to PFC Jones’ room and beat her
    severely, though not severely enough to require medical treatment. A bloody
    and bruised PFC Jones comes to you and states, “I just can’t take this any
    more!”
    What you don’t know:
             1. PFC Jones has a history of being abused physically and
                emotionally.
             2. PFC Jones just received a “Dear Jane Letter”.
             3. PFC Jones’ mother is quite ill.
             4. PFC Jones has been periodically having thought of suicide.
    At one point in your conversation, PFC Jones states, “It’s just not worth it any
    more.”



G-1, Human Resources Policy Directorate                                             3 September 2008   79
                                  Scenario #12 – Deployed PFC
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                                STRATEGIC QUESTIONS:
1. The Army accepts a number of younger individuals who vary in their
   maturity, intellect, and social skills. As senior leadership, what more, if
   anything, can we do to create an environment wherein all Soldiers feel
   safe. Is this even a practical goal? After all, the civilian streets are
   dangerous places too.
2. We want Soldiers to be appropriately aggressive. What do you feel is the
   best way for the organization to respond to hazing, harassment, and
   assaults? Is the JAG the best office to deal with such events? Should there
   be some sort of incident reporting, or surveillance system, for Soldier on
   Soldier aggression?
3. How do we help Soldiers distinguish appropriate from inappropriate
   aggression?
4. Does the battle buddy system work? Why or why not? Are there solid data
   to support the battle buddy system?
5. Is there some practical way to identify “at-risk” individuals before they
   enlist? Would doing so reduce the suicide risk? Could such a system have
   secondary benefits?


G-1, Human Resources Policy Directorate                                             3 September 2008   80
                                  Scenario #12 – Deployed PFC
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

              STRATEGIC QUESTIONS and ANSWERS:
1. The Army accepts a number of younger individuals who vary in their maturity, intellect,
   and social skills. As senior leadership, what more, if anything, can we do to create an
   environment wherein all Soldiers feel safe. Is this even a practical goal? After all, the
   civilian streets are dangerous places too. (for discussion).
2. We want Soldiers to be appropriately aggressive. What do you feel is the best way for
   the organization to respond to hazing, harassment, and assaults? Is the JAG the best
   office to deal with such events? Should there be some sort of incident reporting, or
   surveillance system, for Soldier on Soldier aggression? (for discussion).
3. How do we help Soldiers distinguish appropriate from inappropriate aggression? (for
   discussion)
4. Does the battle buddy system work? Why or why not? Are there solid data to support
   the battle buddy system? (for discussion)
5. Is there some practical way to identify “at-risk” individuals before they enlist? Would
   doing so reduce the suicide risk? Could such a system have secondary benefits?
   (Previous efforts to identify at-risk individuals have failed. However, psychological testing is
   much more sophisticated today and, with sufficient research, a relative risk value can be
   assigned to Soldiers, permitting more precise allocation of resources to those Soldiers
   needing them. There will always be some degree of error when making predictions, but there
   is a certain, probably larger degree of error in our current system. Secondary benefits in
   attrition reduction may also be seen.)




G-1, Human Resources Policy Directorate                                             3 September 2008   81
                                  Scenario #12 – Deployed PFC
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                                  TACTICAL QUESTIONS:
1. Why do you think command did not take quicker action in this case?
2. What can be done to remove obstacles to the free flow of information up
   and down the chain-of-command?
3. Apparently PFC Jones did not disclose the facts that she had been abused,
   that she received a “Dear Jane” letter, or that her mother was seriously ill.
   Some people are more shy and reserved, not wanting to “burden” others
   with their personal problems. How can we identify such individuals and
   make them feel comfortable discussing their problems with their chain-of-
   command?
4. What went wrong, causing this situation to reach a flash point?
5. PFC Jones is discharged three days after being admitted to the psychiatric
   unit. You ask her how she is doing, and she replies, “I convinced them that
   I was not suicidal, and they let me go. However, I am not going to put up
   with SPC Smith’s abuse.” What should you do?




G-1, Human Resources Policy Directorate                                             3 September 2008   82
                                  Scenario #12 – Deployed PFC
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

              TACTICAL QUESTIONS and ANSWERS:
1. Why do you think command did not take quicker action in this case? (For
   discussion)
2. What can be done to remove obstacles to the free flow of information up and
   down the chain-of-command? (for discussion)
3. Apparently PFC Jones did not disclose the facts that she had been abused,
   that she received a “Dear Jane” letter, or that her mother was seriously ill.
   Some people are more shy and reserved, not wanting to “burden” others with
   their personal problems. How can we identify such individuals and make
   them feel comfortable discussing their problems with their chain-of-
   command? (for discussion)
4. What went wrong, causing this situation to reach a flash point? (for
   discussion)
5. PFC Jones is discharged three days after being admitted to the psychiatric
   unit. You ask her how she is doing, and she replies, “I convinced them that I
   was not suicidal, and they let me go. However, I am not going to put up with
   SPC Smith’s abuse.” What should you do? (repeat the ACE procedures as
   necessary).




G-1, Human Resources Policy Directorate                                             3 September 2008   83
                                    Scenario #12 – Deployed PFC
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

                             OPERATIONAL QUESTIONS:
1. How do you clarify what PFC Jones means when she states, “It’s just not
   worth it any more.”
2. During your probe, PFC Jones admits she has been having thoughts about
   suicide. What do you do now?
3. PFC Jones states that she intend to take an overdose of pills and then
   shoot herself in the head with her rifle. How do you respond?
4. The treating physician comes out to you and states “PFC Jones is definitely
   suicidal and she has eloped from the emergency room.” What do you do?
5. PFC Jones is found and admitted to the psychiatric ward. Can you help her
   even while she is hospitalized? If so, how?




G-1, Human Resources Policy Directorate                                             3 September 2008   84
                                    Scenario #12 – Deployed PFC
          Supporting Soldiers, Families & Civilians – Active, Guard, Reserve and Retired

         OPERATIONAL QUESTIONS and ANSWERS:
1. How do you clarify what PFC Jones means when she states, “It’s just not worth it any more.”
   (You must ask probing questions to make sure you understand her correctly. Is she just expressing
   frustration or is making a cry for help. Ask her if she is feeling like harming herself. Don’t take a
   quick “no” for a response. You can say things such as “This is an important question, and I want you
   to give me a thoughtful response” or “I care for you, and I want to make sure you’re safe”.)
2. During your probe, PFC Jones admits she has been having thoughts about suicide. What do
   you do now? (Ask her if she has gone so far as to make a plan and ask what that plan is.)
3. PFC Jones states that she intend to take an overdose of pills and then shoot herself in the
   head with her rifle. How do you respond? (Indicate that suicide is a long-term solution to a short-
   term problem. Demonstrate caring by confiscating PFC Jones’ medications and weapons. Then
   escort her to the emergency room for treatment of her cuts and bruises. Tell the staff in the
   emergency room that you feel PFC Jones is suicidal. While PFC Jones is being treated, call, and
   inform your chain-of-command of that night’s events and your actions.”
4. The treating physician comes out to you and states “PFC Jones is definitely suicidal and she
   has eloped from the emergency room.” What do you do? (Ask the physician if he/she has dialed
   Dial 911 and/or contacted the MP’s. Report PFC Jones’ plans and elopement to your chain-of-
   command. )
5. PFC Jones is found and admitted to the psychiatric ward. Can you help her even while she is
   hospitalized? If so, how? (One can visit her while she is hospitalized and assure her that the other
   members of the unit are awaiting her return. Hopefully, you will be able to tell her that SPC Smith is
   being punished for her actions and that she may be discharged from the army. Make sure that she
   knows that there is no reason to be embarrassed and that the other team members are looking
   forward to her return to duty. One can also inquire if there is anything PFC Jones needs to have
   done while she is hospitalized and offer to take care of these things for her.)


G-1, Human Resources Policy Directorate                                             3 September 2008   85

				
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